Healthcare Provider Details

I. General information

NPI: 1972710762
Provider Name (Legal Business Name): MARTIN L. FLEET, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY RD SE BUILDING 22, SUITE 200
ATLANTA GA
30339-5621
US

IV. Provider business mailing address

1827 POWERS FERRY RD SE BUILDING 22, SUITE 200
ATLANTA GA
30339-5621
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-4744
  • Fax: 770-953-4640
Mailing address:
  • Phone: 770-953-4744
  • Fax: 770-953-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number001154
License Number StateGA

VIII. Authorized Official

Name: DR. MARTIN L. FLEET
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 770-953-4744