Individual
SHIRLEY MEDINA MARTINEZ
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
1517 SARATOGA DR, ALPHARETTA, GA 30022-2887
(678) 461-0179
Mailing address
1517 SARATOGA DR, ALPHARETTA, GA 30022-2887
(678) 461-0179
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
01025076
GA
Other
Enumeration date
06/06/2006
Last updated
07/08/2007
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