Provider Demographics
NPI:1174196760
Name:MARTINAITIS, SANDRA (EDD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:MARTINAITIS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 OLD CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7481
Mailing Address - Country:US
Mailing Address - Phone:770-654-2882
Mailing Address - Fax:
Practice Address - Street 1:2855 OLD CHURCH RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7481
Practice Address - Country:US
Practice Address - Phone:770-654-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional