Provider Demographics
NPI:1255505913
Name:MARTIN, DION NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:DION
Middle Name:NICOLE
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 1:205 BRESEE ST
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-1134
Mailing Address - Country:US
Mailing Address - Phone:229-524-1307
Mailing Address - Fax:
Practice Address - Street 1:205 BRESEE ST
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1134
Practice Address - Country:US
Practice Address - Phone:229-524-1307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAG1197967208000000X
GA63095208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics