MEDICARE: KENDALL MARTIN APC

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	101YM0800X	Mental Health Counselor	APC010111	GA

General Provider Information

NPI Number	:	1457161176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDALL MARTIN APC

Provider Business Mailing Address
First Line	:	515 WAVETREE DR
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-2930
Country	:	US
Telephone Number	:	770-265-7307
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 TRIBBLE GAP RD STE B
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2475
Country	:	US
Telephone Number	:	770-615-0667
Fax Number	:

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

Provider Enumeration Date	:	01/14/2025
Last Update Date	:	05/13/2026

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