Provider Demographics
NPI:1326800210
Name:FIELDS, MADISON LEIGH (MED, NCC, APC)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MED, NCC, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 TEEPEE WAY
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30461-6786
Mailing Address - Country:US
Mailing Address - Phone:912-536-1682
Mailing Address - Fax:
Practice Address - Street 1:326 MYRTLE CROSSING DR
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4688
Practice Address - Country:US
Practice Address - Phone:912-764-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional