Provider Demographics
NPI:1518295237
Name:MARTIN, STEPHANIE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COCA COLA PLZ NW
Mailing Address - Street 2:MEDICAL SERVICES
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-2420
Mailing Address - Country:US
Mailing Address - Phone:251-923-8187
Mailing Address - Fax:
Practice Address - Street 1:1 COCA COLA PLZ NW
Practice Address - Street 2:MEDICAL SERVICES
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313-2420
Practice Address - Country:US
Practice Address - Phone:251-923-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229442363LF0000X
AL1108144363L00000X
FLARNP9347971363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner