Individual
BENITA MADISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3056 ANVIL BLOCK RD STE 118, ELLENWOOD, GA 30294-2864
(404) 366-8100
Mailing address
2898 SUMMIT DR, JONESBORO, GA 30236-6247
(404) 664-2208
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006366
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049255437
DRIVER'S LICENSE
GA
Enumeration date
06/10/2008
Last updated
07/21/2022
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