MEDICARE: THOR MARTIN RN

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	163WE0003X	Emergency Registered Nurse	RN312271	GA

General Provider Information

NPI Number	:	1932057817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOR MARTIN RN

Provider Business Mailing Address
First Line	:	100 COTTAGE CLUB DR SW UNIT 107
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-5534
Country	:	US
Telephone Number	:	706-802-9960
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 HERRELL RD
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-4544
Country	:	US
Telephone Number	:	770-615-6376
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ THOR MARTIN RN” Practice Location

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