Provider Demographics
NPI:1215585815
Name:BAUGH, MADISON VICTORIA
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:VICTORIA
Last Name:BAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BUFORD PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2835
Mailing Address - Country:US
Mailing Address - Phone:478-550-4710
Mailing Address - Fax:
Practice Address - Street 1:CHRIS180
Practice Address - Street 2:1030 FAYETTEVILLE RD
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316
Practice Address - Country:US
Practice Address - Phone:404-486-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health