Provider Demographics
NPI:1255325536
Name:CRENSHAW, MARTHA H (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:H
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1805 PARKE PLAZA CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3498
Mailing Address - Country:US
Mailing Address - Phone:770-469-7000
Mailing Address - Fax:770-879-0436
Practice Address - Street 1:1805 PARKE PLAZA CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3498
Practice Address - Country:US
Practice Address - Phone:770-469-7000
Practice Address - Fax:770-879-0436
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA023580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00247024A1Medicaid
GA0528626OtherAETNA
GA080027160OtherRAILROAD MEDICARE
GA151302OtherBLUE CROSS BLUE SHIELD
GA00247024A1Medicaid