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General NPI Number Information
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NPI Number | 1518519776
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Entity Type | Individual
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Provider Name | MICHAEL JOHN MARTIN JR. MS, LAT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 130 GEORGIA CIR
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City | DAHLONEGA
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State | GA
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Zip | 30597-2745
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Country | US
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Telephone | 678-516-5251
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Fax |
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Provider Business Mailing Address
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Address Line | 304 MILLER DRIVE
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City | DAWSONVILLE
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State | GA
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Zip | 30534-8845
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Country | US
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Telephone | 678-516-5251
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT006417
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT003983
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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