Provider Demographics
NPI:1780374322
Name:MARTIN, CHRISTINA ECKERS
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ECKERS
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 1:1880 BRASELTON HWY STE 118
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2877
Mailing Address - Country:US
Mailing Address - Phone:770-524-4594
Mailing Address - Fax:
Practice Address - Street 1:1880 BRASELTON HWY STE 118
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2877
Practice Address - Country:US
Practice Address - Phone:770-524-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058570136343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)