Provider Demographics
NPI:1629646062
Name:MARTIN, HUNTER
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 NICKVILLE RD NW
Mailing Address - Street 2:
Mailing Address - City:DEWY ROSE
Mailing Address - State:GA
Mailing Address - Zip Code:30634-3106
Mailing Address - Country:US
Mailing Address - Phone:706-371-3480
Mailing Address - Fax:
Practice Address - Street 1:1931 NICKVILLE RD NW
Practice Address - Street 2:
Practice Address - City:DEWY ROSE
Practice Address - State:GA
Practice Address - Zip Code:30634-3106
Practice Address - Country:US
Practice Address - Phone:706-371-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA15Medicaid