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NPI Code Detail

MEDICARE: IMANI MARTIN

MEDICARE: IMANI 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
1106S00000XBehavior TechnicianRBT-26-514332GA

General Provider Information

NPI Number : 1578415410
Entity Type Code : Individual
Provider Name (Legal Business Name) : IMANI MARTIN
Provider Business Mailing Address
First Line : 209 7TH ST FL 3
Second Line :
City : AUGUSTA
State : GA
Zip : 30901-1486
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Provider Business Practice Location Address
First Line : 209 7TH ST
Second Line :
City : AUGUSTA
State : GA
Zip : 30901-1486
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2026
Last Update Date : 02/12/2026

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1467284364 — ANA CONLEY
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Directions to “ IMANI MARTIN ” Practice Location

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