Healthcare Provider Details

I. General information

NPI: 1104187046
Provider Name (Legal Business Name): FONDA D MARTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FONDA D WEBB MD

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CLAIRMONT RD NE STE 903
BROOKHAVEN GA
30329-4402
US

IV. Provider business mailing address

2970 CLAIRMONT RD NE STE 903
BROOKHAVEN GA
30329-4402
US

V. Phone/Fax

Practice location:
  • Phone: 404-334-0003
  • Fax: 404-334-0224
Mailing address:
  • Phone: 404-334-0003
  • Fax: 404-334-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number67101
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14590-320
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number67101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: