Provider Demographics
NPI:1245315118
Name:MARTIN, SARA GELSON (CNNP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:GELSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 SOARING WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:SC
Mailing Address - Zip Code:30062
Mailing Address - Country:US
Mailing Address - Phone:770-423-0029
Mailing Address - Fax:
Practice Address - Street 1:1762 CLIFTON RD NE STE 103
Practice Address - Street 2:EMORY UNIVERSITY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4001
Practice Address - Country:US
Practice Address - Phone:404-686-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169382 NP363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal