Healthcare Provider Details

I. General information

NPI: 1982142808
Provider Name (Legal Business Name): MARTELL HAWKINS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2017
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 YORKTOWNE DR
ATLANTA GA
30349-5317
US

IV. Provider business mailing address

5454 YORKTOWNE DR
ATLANTA GA
30349-5317
US

V. Phone/Fax

Practice location:
  • Phone: 470-344-8719
  • Fax: 470-264-2650
Mailing address:
  • Phone: 470-344-8719
  • Fax: 470-264-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN228567
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: