Individual
MR. JESSE Q. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 MARKET PLACE BLVD, SUITE 200, CARTERSVILLE, GA 30121-8718
(770) 386-7253
(770) 382-6424
Mailing address
1700 HOSPITAL SOUTH DR, SUITE 300, AUSTELL, GA 30106-6810
(770) 944-2830
(678) 581-7170
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
006066
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609174093
NPI NUMBER
GA
Enumeration date
03/09/2011
Last updated
06/09/2011
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