Organization
MADISON FIELDS LPC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MADISON FIELDS MED, LPC (PRACTICE OWNER)
(912) 712-1712
Entity
Organization
Contact information
Practice address
112 PARKER AVE S, BROOKLET, GA 30415-8208
(912) 712-1712
Mailing address
PO BOX 95, BROOKLET, GA 30415-0095
(912) 712-1712
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/14/2026
Last updated
05/14/2026
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