Provider Demographics
NPI:1114066032
Name:MARTIN, BEVERLY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 WENDY BAGWELL PKWY STE 311
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-7814
Mailing Address - Country:US
Mailing Address - Phone:770-222-5881
Mailing Address - Fax:770-222-5883
Practice Address - Street 1:5604 WENDY BAGWELL PKWY STE 311
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7814
Practice Address - Country:US
Practice Address - Phone:770-222-5881
Practice Address - Fax:770-222-5883
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00244592OtherRAILROAD RETIREMENT MEDIC
GAT-95502Medicare UPIN