MEDICARE: MARTHA H GARRISON MD

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	2085R0202X	Diagnostic Radiology Physician	039347	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942255757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA H GARRISON MD

Provider Business Mailing Address
First Line	:	125 E TRINITY PL
Second Line	:	SUITE 201
City	:	DECATUR
State	:	GA
Zip	:	30030-3360
Country	:	US
Telephone Number	:	404-687-8649
Fax Number	:	404-687-8945

Provider Business Practice Location Address
First Line	:	125 E TRINITY PL
Second Line	:	SUITE 201
City	:	DECATUR
State	:	GA
Zip	:	30030-3360
Country	:	US
Telephone Number	:	404-687-8649
Fax Number	:	404-687-8945

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	01/22/2013

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