Provider Demographics
NPI:1649847070
Name:MADRAY, VICTORIA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MICHELLE
Last Name:MADRAY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CHAFEE AVE # FH-100
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5810
Mailing Address - Country:US
Mailing Address - Phone:706-721-6231
Mailing Address - Fax:
Practice Address - Street 1:1004 CHAFEE AVE # FH-100
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5810
Practice Address - Country:US
Practice Address - Phone:706-721-6231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12870207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine