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General NPI Number Information
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NPI Number | 1992051197
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Entity Type | Individual
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Provider Name | ELIZABETH MARTYN NP
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Gender | Female
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 65 CROMWELL CIR
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City | DOUGLAS
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State | GA
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Zip | 31535-7408
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Country | US
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Telephone | 908-461-4843
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Fax |
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Provider Business Mailing Address
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Address Line | 65 CROMWELL CIR
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City | DOUGLAS
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State | GA
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Zip | 31535-7408
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Country | US
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Telephone | 908-461-4843
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN197990
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License Number State | GA
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