Healthcare Provider Details

I. General information

NPI: 1083538045
Provider Name (Legal Business Name): GABRIELLE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 ELEMENTARY DR
FAYETTEVILLE NC
28301-6267
US

IV. Provider business mailing address

9700 GOODEN DR
FAYETTEVILLE NC
28314-5877
US

V. Phone/Fax

Practice location:
  • Phone: 910-678-2708
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: