Provider Demographics
NPI:1447880984
Name:ALVAREZ, MADISON ALICE (PA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ALICE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ALICE
Other - Last Name:DOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3084 MOSS STONE LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-6415
Mailing Address - Country:US
Mailing Address - Phone:770-910-4878
Mailing Address - Fax:
Practice Address - Street 1:3084 MOSS STONE LN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6415
Practice Address - Country:US
Practice Address - Phone:770-910-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant