Healthcare Provider Details

I. General information

NPI: 1437601549
Provider Name (Legal Business Name): DEBORAH A MARTIN, MD, FACS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR SUITE 340
CUMMING GA
30041-7668
US

IV. Provider business mailing address

1400 NORTHSIDE FORSYTH DR SUITE 340
CUMMING GA
30041-7668
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-2144
  • Fax: 770-844-2026
Mailing address:
  • Phone: 770-844-2144
  • Fax: 770-844-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DEBORAH A MARTIN
Title or Position: OWNER
Credential:
Phone: 770-844-2144