Maddison T. Destefano

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

212 W 3Rd St SW
Rome, GA 30165-2802

Phone

(706) 295-4242

Fax

(706) 295-4260

NPI assigned

Sep 25, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1104643626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 S WALL ST",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "307013062",
            "telephone_number": "706-512-3307",
            "fax_number": "706-624-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W 3RD ST SW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301652802",
            "telephone_number": "706-295-4242",
            "fax_number": "706-295-4260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "MADDISON",
        "middle_name": "T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Department of Behavioral Health and Developmental Disabilities
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• Jonathan David Derryberry Jr., CAA
• Belete Ayele Desimmie
• John J Desmond IV, MD
• Jay E Deville, OWNER
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• Diagnostic Systems of Georgia, LLC
• Alfonso Diaz Jr., MD
• Chenoa Dickerson, FNP-C

• All providers in Rome, GA
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.