Healthcare Provider Details

I. General information

NPI: 1437067147
Provider Name (Legal Business Name): MARTIN BRELAND INMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 HAMMOND DR
CANTON GA
30114-6558
US

IV. Provider business mailing address

122 HAMMOND DR
CANTON GA
30114-6558
US

V. Phone/Fax

Practice location:
  • Phone: 210-328-5535
  • Fax:
Mailing address:
  • Phone: 210-328-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number003588
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: