Healthcare Provider Details

I. General information

NPI: 1720302748
Provider Name (Legal Business Name): PATRICIA JEAN MARTERER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

IV. Provider business mailing address

2450 VINSON HWY SE
MILLEDGEVILLE GA
31061-4881
US

V. Phone/Fax

Practice location:
  • Phone: 919-457-1517
  • Fax: 919-363-7697
Mailing address:
  • Phone: 478-445-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003260
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5929
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: