Provider Demographics
NPI:1275185332
Name:ESTES, MADISON PAIGE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:PAIGE
Last Name:ESTES
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 TAYLORS WOOD DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-8954
Mailing Address - Country:US
Mailing Address - Phone:678-458-5983
Mailing Address - Fax:
Practice Address - Street 1:755 HIGHWAY 293
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:GA
Practice Address - Zip Code:30137-2204
Practice Address - Country:US
Practice Address - Phone:404-263-0495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0036642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer