Individual
MADISON BANKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6060 LAKE ACWORTH DR NW STE H, ACWORTH, GA 30101-7358
(404) 729-0501
Mailing address
6060 LAKE ACWORTH DR NW STE H, ACWORTH, GA 30101-7358
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN314135
GA
Other
Enumeration date
04/19/2023
Last updated
04/19/2023
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