Provider Demographics
NPI:1780303271
Name:MARTIN, LAQUISH DENISE
Entity type:Individual
Prefix:
First Name:LAQUISH
Middle Name:DENISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 HAMILTON MILL RD STE 500
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-6010
Mailing Address - Country:US
Mailing Address - Phone:404-917-7560
Mailing Address - Fax:
Practice Address - Street 1:244 PEAVY AVE
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:GA
Practice Address - Zip Code:31091
Practice Address - Country:US
Practice Address - Phone:404-917-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion