Provider Demographics
NPI:1154597946
Name:MARTIN, NICOLLE VENETTA (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLLE
Middle Name:VENETTA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4170 SWEETWATER FLS
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1559
Mailing Address - Country:US
Mailing Address - Phone:678-948-5288
Mailing Address - Fax:470-735-0472
Practice Address - Street 1:720 WESTVIEW DR SW
Practice Address - Street 2:NCPC 339
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1458
Practice Address - Country:US
Practice Address - Phone:404-752-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA62555207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine