Provider Demographics
NPI:1326246158
Name:MARTIN, CECILE ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9121
Mailing Address - Country:US
Mailing Address - Phone:678-990-3962
Mailing Address - Fax:678-840-3777
Practice Address - Street 1:4245 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30024-9121
Practice Address - Country:US
Practice Address - Phone:678-990-3962
Practice Address - Fax:678-840-3777
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN147388 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBLRMMedicare UPIN