Healthcare Provider Details

I. General information

NPI: 1598558116
Provider Name (Legal Business Name): MILISSA MICHELLE MARTIN PCT,CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILISSA MICHELLE HARDIN PCH

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 THUNDER RD
DAHLONEGA GA
30533-4952
US

IV. Provider business mailing address

55 THUNDER RD
DAHLONEGA GA
30533-4952
US

V. Phone/Fax

Practice location:
  • Phone: 706-973-2544
  • Fax:
Mailing address:
  • Phone: 706-973-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: