Provider Demographics
NPI:1639583263
Name:FLETCHER, MARTHA M (DNP/FNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DNP/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:899 ISLAND PARK DR
Practice Address - Street 2:#200
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-8112
Practice Address - Country:US
Practice Address - Phone:843-856-6402
Practice Address - Fax:843-216-5068
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2846Medicaid
SCP01460271OtherRR MEDICARE
SCNP2846Medicaid