Provider Demographics
NPI:1376897561
Name:ADAMOVIC, MARTA (DPT)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:ADAMOVIC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 BISMARK RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4271
Mailing Address - Country:US
Mailing Address - Phone:404-547-5823
Mailing Address - Fax:470-745-0654
Practice Address - Street 1:570 BISMARK RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4271
Practice Address - Country:US
Practice Address - Phone:404-547-5823
Practice Address - Fax:470-745-0654
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129480AMedicaid