Provider Demographics
NPI:1154669307
Name:MARTIN, ALDWIN TERRELL (DC)
Entity Type:Individual
Prefix:DR
First Name:ALDWIN
Middle Name:TERRELL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 LENOX RD NE STE B-2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-6006
Mailing Address - Country:US
Mailing Address - Phone:678-973-0503
Mailing Address - Fax:703-421-2822
Practice Address - Street 1:46169 WESTLAKE DR STE 300
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5875
Practice Address - Country:US
Practice Address - Phone:703-421-2990
Practice Address - Fax:703-421-2822
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557046111N00000X
GACHIRO010067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor