Provider Demographics
NPI:1396754800
Name:MARTIN, KATHLEEN SUSANNE (NP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUSANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4301 STRATFORD CMNS
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-7444
Mailing Address - Country:US
Mailing Address - Phone:404-712-1855
Mailing Address - Fax:404-712-0116
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL
Practice Address - Street 2:1365 CLIFTON ROAD NE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-712-1855
Practice Address - Fax:404-712-0116
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149600163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine