Provider Demographics
NPI:1942255757
Name:GARRISON, MARTHA H (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:H
Last Name:GARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E TRINITY PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3360
Mailing Address - Country:US
Mailing Address - Phone:404-687-8649
Mailing Address - Fax:404-687-8945
Practice Address - Street 1:125 E TRINITY PL
Practice Address - Street 2:SUITE 201
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3360
Practice Address - Country:US
Practice Address - Phone:404-687-8649
Practice Address - Fax:404-687-8945
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0393472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000702534Medicaid
GA000702534Medicaid
GA30BDMSPMedicare PIN
G29653Medicare UPIN
AZZ113417Medicare PIN