Provider Demographics
NPI:1841497054
Name:MADISON, TIFFANY EDWARDS (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:EDWARDS
Last Name:MADISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4990
Mailing Address - Country:US
Mailing Address - Phone:770-442-1111
Mailing Address - Fax:770-740-2990
Practice Address - Street 1:2500 HOSPITAL BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4990
Practice Address - Country:US
Practice Address - Phone:770-442-1111
Practice Address - Fax:770-740-2990
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine