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General NPI Number Information
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NPI Number | 1932057817
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Entity Type | Individual
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Provider Name | THOR MARTIN RN
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Gender | Male
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Dates
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Enumeration Date | 03/17/2026
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 619 HERRELL RD
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City | VILLA RICA
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State | GA
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Zip | 30180-4544
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Country | US
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Telephone | 770-615-6376
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Fax |
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Provider Business Mailing Address
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Address Line | 100 COTTAGE CLUB DR SW UNIT 107
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City | CARTERSVILLE
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State | GA
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Zip | 30120-5534
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Country | US
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Telephone | 706-802-9960
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN312271
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License Number State | GA
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