Provider Demographics
NPI:1265704381
Name:ALLEN, MARTHA EDMONDS (ND,LAC)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:EDMONDS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ND,LAC
Other - Prefix:
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Mailing Address - Street 1:675 PULASKI STREET
Mailing Address - Street 2:STE 1300
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2378
Mailing Address - Country:US
Mailing Address - Phone:706-424-4219
Mailing Address - Fax:706-850-1302
Practice Address - Street 1:675 PULASKI ST
Practice Address - Street 2:STE 1300
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2378
Practice Address - Country:US
Practice Address - Phone:706-424-4219
Practice Address - Fax:706-850-1302
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist