Provider Demographics
NPI:1780567073
Name:MARTIN, DEIJA DENISE
Entity type:Individual
Prefix:
First Name:DEIJA
Middle Name:DENISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 BENDER TRL
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7276
Mailing Address - Country:US
Mailing Address - Phone:177-070-9239
Mailing Address - Fax:
Practice Address - Street 1:2239 BENDER TRL
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7276
Practice Address - Country:US
Practice Address - Phone:177-070-9239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst