Provider Demographics
NPI:1366028664
Name:MADISON, CHELSEA (CSOM, COMT,CBS)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:MADISON
Suffix:
Gender:F
Credentials:CSOM, COMT,CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 N MOUNT JULIET RD STE 225
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8333
Mailing Address - Country:US
Mailing Address - Phone:615-754-2134
Mailing Address - Fax:
Practice Address - Street 1:547 N MOUNT JULIET RD STE 225
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8333
Practice Address - Country:US
Practice Address - Phone:615-754-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7841124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist