Provider Demographics
NPI:1871670968
Name:MARTIN, SHELLEY L (DC)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7854
Mailing Address - Country:US
Mailing Address - Phone:404-272-5394
Mailing Address - Fax:
Practice Address - Street 1:2855 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 760-318
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3563
Practice Address - Country:US
Practice Address - Phone:678-546-0550
Practice Address - Fax:678-546-6885
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHJLMedicare ID - Type Unspecified