Provider Demographics
NPI:1679939847
Name:WATSON, MARTINA
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 HOLCOMB BRIDGE RD
Mailing Address - Street 2:BUILDING 100 SUITE 110
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5223
Mailing Address - Country:US
Mailing Address - Phone:404-389-2120
Mailing Address - Fax:
Practice Address - Street 1:3850 HOLCOMB BRIDGE RD
Practice Address - Street 2:BUILDING 100 SUITE 110
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5223
Practice Address - Country:US
Practice Address - Phone:404-389-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC0008936101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional