MEDICARE: IIKA PETRICE MARTIN

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	104100000X	Social Worker	MSW003772	GA
2	104100000X	Social Worker	130835-01	NY
3	104100000X	Social Worker	15408	TN

General Provider Information

NPI Number	:	1497687131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IIKA PETRICE MARTIN

Provider Business Mailing Address
First Line	:	4076 AKINS RIDGE CT
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-3272
Country	:	US
Telephone Number	:	404-561-9420
Fax Number	:

Provider Business Practice Location Address
First Line	:	4076 AKINS RIDGE CT
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-3272
Country	:	US
Telephone Number	:	404-561-9420
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “ IIKA PETRICE MARTIN ” Practice Location

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