Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2462 | TN |
Y | 207Q00000X | Family Doctor | 03054 | KY |
NPI | 1174735336 |
---|---|
Provider Name | Jared Wilson Madden |
First Address | Harrogate, TN 37752-8202 |
Second Address | Harrogate, TN 37752-8202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 25/06/2013 |