Healthcare Provider Details

I. General information

NPI: 1982150561
Provider Name (Legal Business Name): MARTHA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AH'TRAM INC

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 HARTEL ST
FORT MEADE MD
20755
US

IV. Provider business mailing address

8306 HOLLAND PL
LAWRENCEVILLE GA
30043-8650
US

V. Phone/Fax

Practice location:
  • Phone: 863-968-4852
  • Fax:
Mailing address:
  • Phone: 863-968-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberBL-002344-2020
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number81-1643976
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: