Provider Demographics
NPI:1104187046
Name:MARTIN, FONDA D (MD)
Entity Type:Individual
Prefix:DR
First Name:FONDA
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FONDA
Other - Middle Name:D
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:833 CAMPBELL HILL ST NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1134
Mailing Address - Country:US
Mailing Address - Phone:770-528-0260
Mailing Address - Fax:770-528-0269
Practice Address - Street 1:833 CAMPBELL HILL ST NW
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1134
Practice Address - Country:US
Practice Address - Phone:770-528-0260
Practice Address - Fax:770-528-0269
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67101207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology