1558326413 NPI number — DR. DEBORAH A MARTIN MD

Table of content: DR. DEBORAH A MARTIN MD (NPI 1558326413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558326413 NPI number — DR. DEBORAH A MARTIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
DEBORAH
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558326413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3265 N POINT PKWY STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-4711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-844-2144
Provider Business Mailing Address Fax Number:
678-404-5355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3265 N POINT PKWY STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30005-4711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-844-2144
Provider Business Practice Location Address Fax Number:
678-404-5355
Provider Enumeration Date:
04/20/2006

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: 208600000X , with the licence number:  032246 , 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: 000405127A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 032246 . This is a "GEORGIA MEDICAL LICENSING BOARD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11399 . This is a "FIRST HEALTH COVENTRY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 133861084444 . This is a "HUMANA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: PR27874000001 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000405127E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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