Individual
MR. JACK ENOCH MADSEN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
5445 MERIDIAN MARK RD, STE. 390, ATLANTA, GA 30342-4763
(404) 237-3668
(404) 237-9563
Mailing address
900 CIRCLE 75 PKWY SE, STE. 900, ATLANTA, GA 30339-3035
(678) 426-2171
(404) 446-1957
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD001281
GA
Other
Enumeration date
05/08/2012
Last updated
02/10/2022
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