Provider Demographics
NPI:1811058688
Name:MARTIN, AMY SMITH (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SMITH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MINTER DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-0728
Mailing Address - Country:US
Mailing Address - Phone:478-396-4972
Mailing Address - Fax:478-218-5226
Practice Address - Street 1:321 MINTER DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-0728
Practice Address - Country:US
Practice Address - Phone:478-396-4972
Practice Address - Fax:478-218-5226
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist