Provider Demographics
NPI:1356934772
Name:SERAPHIN, MARTINE (CCMA)
Entity type:Individual
Prefix:MISS
First Name:MARTINE
Middle Name:
Last Name:SERAPHIN
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1717
Mailing Address - Country:US
Mailing Address - Phone:678-428-9599
Mailing Address - Fax:
Practice Address - Street 1:2170 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1717
Practice Address - Country:US
Practice Address - Phone:678-428-9599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000000000208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice