Provider Demographics
NPI:1982741831
Name:MARTIN, MAUREEN G (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BUFORD HIGHWAY
Mailing Address - Street 2:SUITE 508
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-636-1108
Mailing Address - Fax:404-636-9482
Practice Address - Street 1:2801 BUFORD HIGHWAY
Practice Address - Street 2:SUITE 508
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-636-1108
Practice Address - Fax:404-636-9482
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4811041C0700X
GA299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist