Provider Demographics
NPI:1891169264
Name:MADISON, MEREDITH
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:MADISON
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 1:5710 WATERMELON ROAD
Mailing Address - Street 2:SUITE 600 TUSCALOOSA INTEGRATIVE FAMILY MEDICINE
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5710 WATERMELON ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35473
Practice Address - Country:US
Practice Address - Phone:205-345-6272
Practice Address - Fax:205-758-1493
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-129419163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse