Provider Demographics
NPI:1316037807
Name:BREWER, MARTHA J (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:BREWER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2655 NORTHWINDS PKWY
Mailing Address - Street 2:JACKSON SURGICAL ASSISTANTS BILLING
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2280
Mailing Address - Country:US
Mailing Address - Phone:877-230-9617
Mailing Address - Fax:877-281-8770
Practice Address - Street 1:2655 NORTHWINDS PKWY
Practice Address - Street 2:JACKSON SURGICAL ASSISTANTS BILLING
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2280
Practice Address - Country:US
Practice Address - Phone:877-230-9617
Practice Address - Fax:877-281-8770
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA06293R207V00000X
GA71211207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1359513Medicaid
AR159580001Medicaid
5N464Medicare PIN
LA5L931F669Medicare PIN
B61558Medicare UPIN