Individual
MADISON MARIE WICKLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
980 JOHNSON FERRY RD STE 1040, ATLANTA, GA 30342-1609
(770) 292-3490
(404) 300-2317
Mailing address
980 JOHNSON FERRY RD STE 1040, ATLANTA, GA 30342-1609
(770) 292-3490
(404) 300-2317
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10258
GA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
08/05/2019
Last updated
05/26/2021
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