Healthcare Provider Details

I. General information

NPI: 1194837153
Provider Name (Legal Business Name): ANA ISABEL GUINEA-MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 NORTH AVE NE C-30
ATLANTA GA
30308-2857
US

IV. Provider business mailing address

1001 HAMPTON FALL BLVD APT 112
BROWNSBORO AL
35741-8002
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-6820
  • Fax: 678-904-6824
Mailing address:
  • Phone: 256-539-3014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0026097
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: