Provider Demographics
NPI:1043009921
Name:POOR, MADISON DAWN
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:DAWN
Last Name:POOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 WYNDHAM LN
Mailing Address - Street 2:
Mailing Address - City:MARVIN
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6632
Mailing Address - Country:US
Mailing Address - Phone:704-877-4954
Mailing Address - Fax:
Practice Address - Street 1:509 WYNDHAM LN
Practice Address - Street 2:
Practice Address - City:MARVIN
Practice Address - State:NC
Practice Address - Zip Code:28173-6632
Practice Address - Country:US
Practice Address - Phone:704-877-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program