Provider Demographics
NPI:1205358132
Name:MALONE, MADISON ELIZABETH
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ELIZABETH
Last Name:MALONE
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 1:11019 EVEREST CIR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2832
Mailing Address - Country:US
Mailing Address - Phone:256-682-7951
Mailing Address - Fax:
Practice Address - Street 1:11019 EVEREST CIRCLE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803
Practice Address - Country:US
Practice Address - Phone:256-682-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program