Healthcare Provider Details

I. General information

NPI: 1497904643
Provider Name (Legal Business Name): MARTHA JEAN RYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

116 5TH AVE
DECATUR GA
30030-4808
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3381
  • Fax: 404-778-4295
Mailing address:
  • Phone: 404-938-8682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN214873
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167986
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: