MEDICARE: DR. BEVERLY LYNN MARTIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR001404	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00244592	OTHER	GA	RAILROAD RETIREMENT MEDIC

General Provider Information

NPI Number	:	1114066032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY LYNN MARTIN D.C.

Provider Business Mailing Address
First Line	:	5604 WENDY BAGWELL PKWY STE 311
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-7814
Country	:	US
Telephone Number	:	770-222-5881
Fax Number	:	770-222-5883

Provider Business Practice Location Address
First Line	:	5604 WENDY BAGWELL PKWY STE 311
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-7814
Country	:	US
Telephone Number	:	770-222-5881
Fax Number	:	770-222-5883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	09/15/2022

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