Individual
MRS. JACQUELYN HAIRSTON MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C-FNP
Contact information
Practice address
107 UPPER RIVERDALE RD SW, SUITE B, RIVERDALE, GA 30274-2540
(770) 692-2800
(770) 692-2804
Mailing address
2746 DODSON LEE DR, EAST POINT, GA 30344-3960
(404) 346-1330
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN052052
GA
Other
Enumeration date
12/19/2006
Last updated
07/08/2007
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