Healthcare Provider Details

I. General information

NPI: 1750678512
Provider Name (Legal Business Name): DAWN MARGARET MARTIN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 SAVOY DR SUITE 101
ATLANTA GA
30341-1072
US

IV. Provider business mailing address

1226 VISTA VALLEY DR NE
ATLANTA GA
30329-3452
US

V. Phone/Fax

Practice location:
  • Phone: 770-234-0981
  • Fax: 770-234-0252
Mailing address:
  • Phone: 770-310-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number185544
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number185544
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: