Provider Demographics
NPI:1316367006
Name:MARTIN, JACQUELINE MARINA (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARINA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3121 PANTHERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3830
Mailing Address - Country:US
Mailing Address - Phone:404-270-8192
Mailing Address - Fax:404-270-8183
Practice Address - Street 1:3121 PANTHERSVILLE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3830
Practice Address - Country:US
Practice Address - Phone:404-270-8192
Practice Address - Fax:404-270-8183
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50656207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology