Healthcare Provider Details

I. General information

NPI: 1497546592
Provider Name (Legal Business Name): SAVANNA MAYE MARTIN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 BRANDY RUN DR APT 209
MECHANICSVILLE VA
23111-3710
US

IV. Provider business mailing address

7105 BRANDY RUN DR APT 209
MECHANICSVILLE VA
23111-3710
US

V. Phone/Fax

Practice location:
  • Phone: 804-298-4722
  • Fax:
Mailing address:
  • Phone: 804-298-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000065109
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: