MEDICARE: JOHN WESLEY 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	101YP2500X	Professional Counselor	APC010278	GA

General Provider Information

NPI Number	:	1972194264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WESLEY MARTIN

Provider Business Mailing Address
First Line	:	6425 POWERS FERRY RD NW
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30339
Country	:	US
Telephone Number	:	866-922-2089
Fax Number	:

Provider Business Practice Location Address
First Line	:	6425 POWERS FERRY RD NW
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30339
Country	:	US
Telephone Number	:	866-922-2089
Fax Number	:

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

Provider Enumeration Date	:	01/29/2021
Last Update Date	:	03/21/2025

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