Provider Demographics
NPI:1740879428
Name:TRUMAN, MADISON (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:TRUMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 STURBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37642-4700
Mailing Address - Country:US
Mailing Address - Phone:423-765-8344
Mailing Address - Fax:
Practice Address - Street 1:420 W MORRIS BLVD STE 400D
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2282
Practice Address - Country:US
Practice Address - Phone:423-586-7509
Practice Address - Fax:423-581-5701
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007619363A00000X
TN4349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant