Provider Demographics
NPI:1881862639
Name:MARTIN, THELEMA C (RD)
Entity Type:Individual
Prefix:MS
First Name:THELEMA
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:THELMA
Other - Middle Name:C
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5605 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1365
Mailing Address - Country:US
Mailing Address - Phone:678-527-0800
Mailing Address - Fax:678-244-9010
Practice Address - Street 1:5605 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 1050
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1365
Practice Address - Country:US
Practice Address - Phone:678-527-0800
Practice Address - Fax:678-244-9010
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001673133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ04751Medicare UPIN