Provider Demographics
NPI:1063492742
Name:MARTIN, PAULA GUNTER (CRNA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:GUNTER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1549
Mailing Address - Country:US
Mailing Address - Phone:404-778-8311
Mailing Address - Fax:770-495-1585
Practice Address - Street 1:6325 HOSPITAL PKWY
Practice Address - Street 2:EMORY JOHNS CREEK HOSP
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5775
Practice Address - Country:US
Practice Address - Phone:404-778-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-035383207L00000X
AL1035383367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051507772OtherBC OF AL
AL1063492742OtherMEDICARE 510I430397
AL009958585Medicaid
AL009958585Medicaid