1598558116 NPI number — MS. MILISSA MICHELLE MARTIN PCT,CNA

Table of content: MS. MILISSA MICHELLE MARTIN PCT,CNA (NPI 1598558116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598558116 NPI number — MS. MILISSA MICHELLE MARTIN PCT,CNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
MILISSA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PCT,CNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARDIN
Provider Other First Name:
MILISSA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PCH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598558116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 THUNDER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAHLONEGA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30533-4952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-973-2544
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 THUNDER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAHLONEGA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30533-4952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-973-2544
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2025

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: 261QM0850X , 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)





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