Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 218992 | GA |
NPI | 1003307000 |
---|---|
Provider Name | Sandra Ann Martin |
First Address | Ringgold, GA 30736-9037 |
Second Address | Ringgold, GA 30736-9037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2018 |
Last Update Date | 24/05/2018 |