Individual
JAMITA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6468 HWY 92, SUITE 140, ACWORTH, GA 30102-0005
(770) 634-9994
(855) 413-6890
Mailing address
PO BOX 2298, ACWORTH, GA 30102-0005
(770) 634-9994
(855) 413-6890
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
LC20150000857
GA
Other
Enumeration date
12/30/2015
Last updated
12/30/2015
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