Provider Demographics
NPI:1609174093
Name:MARTIN, JESSE Q (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:Q
Last Name:MARTIN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1700 HOSPITAL SOUTH DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6810
Mailing Address - Country:US
Mailing Address - Phone:770-944-2830
Mailing Address - Fax:678-581-7170
Practice Address - Street 1:100 MARKET PLACE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8718
Practice Address - Country:US
Practice Address - Phone:770-386-7253
Practice Address - Fax:770-382-6424
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-06-09
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Provider Licenses
StateLicense IDTaxonomies
GA006066363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1609174093OtherNPI NUMBER