Provider Demographics
NPI:1770256836
Name:MADISON PHYSICIAN GROUP INC
Entity type:Organization
Organization Name:MADISON PHYSICIAN GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-308-6335
Mailing Address - Street 1:340 WAYNICK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-9166
Mailing Address - Country:US
Mailing Address - Phone:931-308-6335
Mailing Address - Fax:731-660-2121
Practice Address - Street 1:379 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2080
Practice Address - Country:US
Practice Address - Phone:731-661-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty