Provider Demographics
NPI:1972524700
Name:MARTIN, MICHELLE RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 WINDY HILL RD SE #106
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:770-980-1110
Mailing Address - Fax:770-980-1210
Practice Address - Street 1:2550 WINDY HILL RD SE STE 106
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8607
Practice Address - Country:US
Practice Address - Phone:770-980-1110
Practice Address - Fax:770-980-1210
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052360207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA040748747DMedicaid