Individual
DANIELLE MADLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
5701 MABLETON PKWY SW STE 348, MABLETON, GA 30126-3395
(470) 454-3653
Mailing address
4696 BALLEY SHANNON DR SE, MABLETON, GA 30126-1763
(678) 360-2368
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN208494
GA
363LF0000X
Family Nurse Practitioner
Primary
RN208494
GA
Other
Enumeration date
04/22/2016
Last updated
10/13/2025
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