1386662237 NPI number — STEPHANIE S MARTIN MD

Table of content: STEPHANIE S MARTIN MD (NPI 1386662237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386662237 NPI number — STEPHANIE S MARTIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
STEPHANIE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BANKSON
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386662237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3280 HOWELL MILL ROAD NW
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30327-1181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-973-2444
Provider Business Mailing Address Fax Number:
404-935-9832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3280 HOWELL MILL ROAD NW
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30327-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-973-2444
Provider Business Practice Location Address Fax Number:
404-935-9832
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  048913 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000867787C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com