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General NPI Number Information
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NPI Number | 1194303420
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Entity Type | Individual
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Provider Name | MARTHA JANE WILLIS
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Gender | Female
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 999 WHITLOCK AVE SW STE 8
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City | MARIETTA
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State | GA
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Zip | 30064-1995
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Country | US
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Telephone | 770-422-6644
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Fax |
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Provider Business Mailing Address
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Address Line | 309 PEACOCK DR NW
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City | MARIETTA
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State | GA
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Zip | 30064-1815
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Country | US
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Telephone | 404-625-6605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | HADS001054
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License Number State |
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