Healthcare Provider Details

I. General information

NPI: 1457273724
Provider Name (Legal Business Name): LAUREN CYDNEE MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CHURCH ST NE STE 400
MARIETTA GA
30060-8957
US

IV. Provider business mailing address

790 CHURCH ST NE STE 400
MARIETTA GA
30060-8957
US

V. Phone/Fax

Practice location:
  • Phone: 678-239-0420
  • Fax:
Mailing address:
  • Phone: 770-405-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN718889
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number718889
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number989762
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718889
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: