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General NPI Number Information
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NPI Number | 1669806121
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Entity Type | Individual
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Provider Name | MARTHA SANDRA AMAYA
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Gender | Female
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Dates
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Enumeration Date | 09/02/2013
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Last Update Date | 09/02/2013
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Provider Practice Location Address
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Address Line | 108 OOTHCALOOGA ST
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City | CALHOUN
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State | GA
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Zip | 30701-2332
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Country | US
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Telephone | 706-844-2172
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Fax |
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Provider Business Mailing Address
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Address Line | 620 JOHNSON LAKE RD SE
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City | ADAIRSVILLE
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State | GA
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Zip | 30103-3707
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Country | US
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Telephone | 706-844-2172
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MT009079
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License Number State | GA
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