Provider Demographics
NPI:1023415528
Name:MARTIN, MICHAEL C (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W PONCE DE LEON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2441
Mailing Address - Country:US
Mailing Address - Phone:404-537-2521
Mailing Address - Fax:
Practice Address - Street 1:315 W PONCE DE LEON AVE STE 110
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2441
Practice Address - Country:US
Practice Address - Phone:404-537-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109166363AM0700X
363AM0700X
GA7437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical