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1316037807

NPI Code Detail

MEDICARE: MARTHA J BREWER MD

MEDICARE: MARTHA J BREWER MD

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	207V00000X	Obstetrics & Gynecology Physician	06293R	LA
2	207VG0400X	Gynecology Physician	71211	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316037807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA J BREWER MD

Provider Business Mailing Address
First Line	:	2655 NORTHWINDS PKWY
Second Line	:	JACKSON SURGICAL ASSISTANTS BILLING
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2280
Country	:	US
Telephone Number	:	877-230-9617
Fax Number	:	877-281-8770

Provider Business Practice Location Address
First Line	:	2655 NORTHWINDS PKWY
Second Line	:	JACKSON SURGICAL ASSISTANTS BILLING
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2280
Country	:	US
Telephone Number	:	877-230-9617
Fax Number	:	877-281-8770

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	10/01/2014

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Directions to “ MARTHA J BREWER MD” Practice Location

Language	Start Address	Practice Location

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