Individual
MARTHALENE LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4514 YORKTOWN DR, BETHLEHEM, GA 30620-4826
(678) 635-5463
Mailing address
250 NORTH AVE, ATHENS, GA 30601-2244
(706) 389-6790
(706) 389-6760
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/01/2014
Last updated
10/01/2014
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