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

Madison Marie Wickline

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1174178370

Madison Marie Wickline is a Physician Assistant in Atlanta, Georgia. Qualified in 2020, 6 years ago. Accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
6
Licensed in
GA
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

980 Johnson Ferry Rd Ste 1040
Atlanta, GA 30342-1609
Phone: (770) 292-3490
Fax: (404) 300-2317
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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 10258 (GA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1174178370
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 5, 2019
Last updated in NPPESMay 26, 2021
Certification dateMay 26, 2021
Mailing address980 Johnson Ferry Rd Ste 1040, Atlanta, GA 30342-1609

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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