Organization
BOUTIQUEGYN WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FONDA D. MARTIN MD (CEO/FOUNDER)
(713) 878-7102
Entity
Organization
Contact information
Practice address
2970 CLAIRMONT RD NE, BROOKHAVEN, GA 30329-1638
(713) 878-7102
Mailing address
530 SEMIRA ST SW, ATLANTA, GA 30331-8378
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
Other
Enumeration date
09/12/2024
Last updated
09/12/2024
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