Provider Demographics
NPI:1497644140
Name:TIDWELL, MADELINE DRUMMOND (DMD)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:DRUMMOND
Last Name:TIDWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 SUGAR VALLEY RD SW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-5603
Mailing Address - Country:US
Mailing Address - Phone:706-266-7392
Mailing Address - Fax:
Practice Address - Street 1:15 PROFESSIONAL CT SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2844
Practice Address - Country:US
Practice Address - Phone:706-291-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1237941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice