Provider Demographics
NPI:1063548444
Name:MARTIN, CATHY A (RN 047911)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN 047911
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2144
Mailing Address - Country:US
Mailing Address - Phone:478-751-6119
Mailing Address - Fax:478-751-6099
Practice Address - Street 1:114 FOREST AVENUE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31032
Practice Address - Country:US
Practice Address - Phone:478-986-3164
Practice Address - Fax:478-986-3339
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 047911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse