Provider Demographics
NPI:1790883767
Name:MARTIN, LAURA J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:49 JESSE HILL JR DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3049
Mailing Address - Country:US
Mailing Address - Phone:404-778-1633
Mailing Address - Fax:404-778-1602
Practice Address - Street 1:49 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3049
Practice Address - Country:US
Practice Address - Phone:404-778-1633
Practice Address - Fax:404-778-1602
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA34659207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE89206Medicare UPIN
GA11BDDKGMedicare ID - Type Unspecified