Healthcare Provider Details

I. General information

NPI: 1528247525
Provider Name (Legal Business Name): JULIE SEALE MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OGLETHORPE AVE STE 600CD
ATHENS GA
30606-2179
US

IV. Provider business mailing address

PO BOX 161435
ATLANTA GA
30321-1435
US

V. Phone/Fax

Practice location:
  • Phone: 706-559-4171
  • Fax: 706-559-4177
Mailing address:
  • Phone: 706-369-5440
  • Fax: 706-369-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number069686
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number069686
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: