Provider Demographics
NPI:1578864328
Name:MARTIN, BRENDA JEAN (PP, BA)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:JEAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PP, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3142
Mailing Address - Country:US
Mailing Address - Phone:706-323-7244
Mailing Address - Fax:706-596-0424
Practice Address - Street 1:2401 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3142
Practice Address - Country:US
Practice Address - Phone:706-323-7244
Practice Address - Fax:706-596-0424
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator