| Martin Medical Slp Llc | |
|
103 Due West Pass, Dallas, GA 30157-2545 | |
| (404) 556-7053 | |
| Not Available |
| Full Name | Martin Medical Slp Llc |
|---|---|
| Type | Facility |
| Speciality | Speech-language Pathologist |
| Location | 103 Due West Pass, Dallas, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114526811 | NPI | - | NPPES |
| 10005249 | Other | GA | NATIONAL AFFILIATION |
| 1417565532 | Other | GA | INDIVIDUAL NPI |
| SLP007542 | Other | GA | STATE LICENSURE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Primary |
| Provider Name | Charlene Samone Martin |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1417565532 PECOS PAC ID: 6709296452 Enrollment ID: I20201109000315 |
| Mailing Address | Practice Location Address |
|---|---|
| Martin Medical Slp Llc 103 Due West Pass, Dallas, GA 30157-2545 Ph: (404) 556-7053 | Martin Medical Slp Llc 103 Due West Pass, Dallas, GA 30157-2545 Ph: (404) 556-7053 |
Leah Reilly Nichols, CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 3044 Due West Road, Dallas, GA 30157 Phone: 770-443-9672 | |
Amy Mason, SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 3044 Due West Rd, Dallas, GA 30157 Phone: 770-443-9672 Fax: 770-505-3595 | |
Emily Gantt, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 283 Red Hawk Way, Dallas, GA 30132 Phone: 561-801-3148 | |
Mary Kathleen Morris, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 3044 Due West Rd, Dallas, GA 30157 Phone: 770-443-9672 | |
Andrea Baerwalde, M.S., CCC-SLP Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 71 Garland Rose Ln, Dallas, GA 30157 Phone: 770-380-2067 Fax: 770-974-7631 | |
Clifton Young, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 3044 Due West Rd, Dallas, GA 30157 Phone: 770-443-9672 | |
Jessica Duffey, Speech-Language Pathologist Medicare: Not Enrolled in Medicare Practice Location: 3044 Due West Rd, Dallas, GA 30157 Phone: 770-443-9672 |