Healthcare Provider Details

I. General information

NPI: 1972036655
Provider Name (Legal Business Name): NANCY MARTINEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 KENNESAW DUE WEST RD NW STE 625
KENNESAW GA
30152-4305
US

IV. Provider business mailing address

1600 KENNESAW DUE WEST RD NW STE 625
KENNESAW GA
30152-4305
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-5880
  • Fax: 866-777-2178
Mailing address:
  • Phone: 770-422-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN216925
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: