Provider Demographics
NPI:1578009254
Name:GIDDINGS, MARTHA M (PHD, LLC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:M
Last Name:GIDDINGS
Suffix:
Gender:F
Credentials:PHD, LLC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:J
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3790 OLD US HIGHWAY 41 N STE A
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6865
Mailing Address - Country:US
Mailing Address - Phone:229-262-1000
Mailing Address - Fax:229-262-1085
Practice Address - Street 1:3790 OLD US HIGHWAY 41 N STE A
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6865
Practice Address - Country:US
Practice Address - Phone:229-262-1000
Practice Address - Fax:229-262-1085
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0006141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14004763OtherCAQH NUMBER
GA1578009254OtherNPI