Provider Demographics
NPI:1497914956
Name:MADDEN, JOANN (APRN)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:MADDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:LATIMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2638 TWO NOTCH RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1432
Mailing Address - Country:US
Mailing Address - Phone:803-256-2500
Mailing Address - Fax:803-758-1726
Practice Address - Street 1:2638 TWO NOTCH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1432
Practice Address - Country:US
Practice Address - Phone:803-256-2500
Practice Address - Fax:803-758-1726
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3159364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1244Medicaid
SCNP1244Medicaid