Provider Demographics
NPI:1518948421
Name:BRAWNER, MADISON TUCKER SR (DPM)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:TUCKER
Last Name:BRAWNER
Suffix:SR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4507
Mailing Address - Country:US
Mailing Address - Phone:912-354-9990
Mailing Address - Fax:912-352-2304
Practice Address - Street 1:817 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4507
Practice Address - Country:US
Practice Address - Phone:912-354-9990
Practice Address - Fax:912-352-2304
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000456213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000178912AMedicaid
GA000178912AMedicaid
GAU01658Medicare UPIN
GA480004440Medicare PIN