Provider Demographics
NPI:1558326413
Name:MARTIN, DEBORAH A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 340
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6017
Mailing Address - Country:US
Mailing Address - Phone:770-844-2144
Mailing Address - Fax:770-844-2026
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 340
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6017
Practice Address - Country:US
Practice Address - Phone:770-844-2144
Practice Address - Fax:770-844-2026
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032246208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11399OtherFIRST HEALTH COVENTRY
GA000405127EMedicaid
GA000405127AMedicaid
GA133861084444OtherHUMANA
GA032246OtherGEORGIA MEDICAL LICENSING BOARD
GAPR27874000001OtherCIGNA