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NPI Code Detail

MEDICARE: NEIL P MARTIN LLC

MEDICARE: NEIL P MARTIN LLC
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
1103T00000XPsychologistPSY004040GA

General Provider Information

NPI Number : 1487172300
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEIL P MARTIN LLC
Provider Business Mailing Address
First Line : 67 PEACHTREE PARK DR NE STE 102
Second Line :
City : ATLANTA
State : GA
Zip : 30309-1318
Country : US
Telephone Number : 404-410-2448
Fax Number : 404-581-5375
Provider Business Practice Location Address
First Line : 67 PEACHTREE PARK DR NE STE 102
Second Line :
City : ATLANTA
State : GA
Zip : 30309-1318
Country : US
Telephone Number : 404-410-2448
Fax Number : 404-581-5375
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. NEIL MARTIN
Credential : PSYD
Telephone Number : 404-410-2448
Provider Enumeration Date : 08/30/2017
Last Update Date : 07/21/2022

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