Provider Demographics
NPI:1558086397
Name:DESCH, MADISON RACHELLE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:RACHELLE
Last Name:DESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 SHERWOOD OAKS RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5209
Mailing Address - Country:US
Mailing Address - Phone:913-609-9710
Mailing Address - Fax:
Practice Address - Street 1:434 SHERWOOD OAKS RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5209
Practice Address - Country:US
Practice Address - Phone:913-609-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant