Provider Demographics
NPI:1013739028
Name:MUSGROVE, MADISON PAIGE (ADC-IP)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:PAIGE
Last Name:MUSGROVE
Suffix:
Gender:F
Credentials:ADC-IP
Other - Prefix:MRS
Other - First Name:MADISON
Other - Middle Name:PAIGE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 HUMAN SERVICES RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7548
Mailing Address - Country:US
Mailing Address - Phone:864-833-6500
Mailing Address - Fax:
Practice Address - Street 1:219 HUMAN SERVICES RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7548
Practice Address - Country:US
Practice Address - Phone:864-833-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCADC-IP29082083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine