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Organization
MARTIN MEDICAL SLP LLC
Active
Organization
MARTIN MEDICAL SLP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE SAMONE MARTIN M.S. CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(404) 556-7053
Entity
Organization
Contact information
Practice address
103 DUE WEST PASS, DALLAS, GA 30157-2545
(404) 556-7053
Mailing address
103 DUE WEST PASS, DALLAS, GA 30157-2545
(404) 556-7053
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10005249
NATIONAL AFFILIATION
GA
01
—
1417565532
INDIVIDUAL NPI
GA
01
—
SLP007542
STATE LICENSURE
GA
Enumeration date
10/22/2020
Last updated
10/22/2020
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