Healthcare Provider Details

I. General information

NPI: 1629690466
Provider Name (Legal Business Name): JASMIN LUCIA MARTINEZ AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 PEACHTREE DUNWOODY RD STE 1280
ATLANTA GA
30342-4792
US

IV. Provider business mailing address

5670 PEACHTREE DUNWOODY RD STE 1280
ATLANTA GA
30342-4792
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-1589
  • Fax: 404-303-1950
Mailing address:
  • Phone: 404-257-1589
  • Fax: 404-303-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004396
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: