Healthcare Provider Details

I. General information

NPI: 1538079892
Provider Name (Legal Business Name): MARION ALLISON MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2599 CHURCH ST NW
ATLANTA GA
30318-1828
US

IV. Provider business mailing address

2599 CHURCH ST NW
ATLANTA GA
30318-1828
US

V. Phone/Fax

Practice location:
  • Phone: 770-547-9931
  • Fax:
Mailing address:
  • Phone: 770-547-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: