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General NPI Number Information
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NPI Number | 1922625482
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Entity Type | Individual
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Provider Name | TATIANA ALEXANDRA MARTINEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 06/25/2022
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Provider Practice Location Address
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Address Line | 451 NORTHOLT PKWY
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City | SUWANEE
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State | GA
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Zip | 30024-4362
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Country | US
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Telephone | 648-680-4290
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Fax |
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Provider Business Mailing Address
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Address Line | 821 HILLSIDE DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-3116
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Country | US
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Telephone | 404-307-4824
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9776
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License Number State | GA
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