Provider Demographics
NPI:1215181128
Name:MARTIN, JANET STILLMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:STILLMAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 JENNINGS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2552
Mailing Address - Country:US
Mailing Address - Phone:706-338-9551
Mailing Address - Fax:706-549-3596
Practice Address - Street 1:1551 JENNINGS MILL RD
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2552
Practice Address - Country:US
Practice Address - Phone:706-338-9551
Practice Address - Fax:706-549-3596
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1134103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool