MEDICARE: MARTANA ELDRIDGE

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	1041C0700X	Clinical Social Worker	CSW007322	GA

General Provider Information

NPI Number	:	1235725789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTANA ELDRIDGE

Provider Business Mailing Address
First Line	:	2694 N MARTIN ST
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6900
Country	:	US
Telephone Number	:	716-771-9961
Fax Number	:

Provider Business Practice Location Address
First Line	:	2694 N MARTIN ST
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6900
Country	:	US
Telephone Number	:	716-771-9961
Fax Number	:

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

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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Directions to “ MARTANA ELDRIDGE ” Practice Location

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