Provider Demographics
NPI:1952621476
Name:CLELLAND, MARTHA PAUL (CSA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:PAUL
Last Name:CLELLAND
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 960
Mailing Address - Street 2:BLUE SPRINGS ROAD
Mailing Address - City:PINEVIEW
Mailing Address - State:GA
Mailing Address - Zip Code:31071-9762
Mailing Address - Country:US
Mailing Address - Phone:478-783-4563
Mailing Address - Fax:
Practice Address - Street 1:901 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6720
Practice Address - Country:US
Practice Address - Phone:478-448-4106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSA 3548246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist