Provider Demographics
NPI:1851090054
Name:AMBORSKI, MADISON NOEL
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:NOEL
Last Name:AMBORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 OLD DAHLONEGA HWY
Mailing Address - Street 2:
Mailing Address - City:MURRAYVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30564-1227
Mailing Address - Country:US
Mailing Address - Phone:773-456-8558
Mailing Address - Fax:
Practice Address - Street 1:130 GEORGIA CIR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533
Practice Address - Country:US
Practice Address - Phone:773-456-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0044612255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program