Provider Demographics
NPI:1710089057
Name:MARTIN, JIM (CPT,FNP-C,MSN,AEMT)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CPT,FNP-C,MSN,AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 CLINIC AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4454
Mailing Address - Country:US
Mailing Address - Phone:770-214-2800
Mailing Address - Fax:770-214-2803
Practice Address - Street 1:157 CLINIC AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4454
Practice Address - Country:US
Practice Address - Phone:770-214-2800
Practice Address - Fax:770-214-2803
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner