Provider Demographics
NPI:1013948330
Name:DORSEY, MARTHA J (ANPRN)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:J
Last Name:DORSEY
Suffix:
Gender:F
Credentials:ANPRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:339 SINCLAIR AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-728-7748
Practice Address - Fax:404-728-7782
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN047265NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN047265NPMedicare UPIN