Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Madison Mandula Bazemore, PA

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1306583323

Madison Mandula Bazemore, PA is a Physician Assistant in Gainesville, Georgia. Qualified in 2023, 3 years ago. Practices with Northeast Georgia Physicians Group Inc, a 892-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
3
Licensed in
GA
In the registry since
2022
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1315 Jesse Jewell Pkwy NE Ste 300
Gainesville, GA 30501-3875
Phone: (770) 848-6190
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 11992 (GA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1306583323
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 20, 2022
Last updated in NPPESDecember 20, 2023
Certification dateDecember 20, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Northeast Georgia Physicians Group Inc — 892 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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