Provider Demographics
NPI:1972526093
Name:BOONE, MARTHA B (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:B
Last Name:BOONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 A OLD MILTON PARKWAY
Mailing Address - Street 2:SUITE 560
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:404-705-8366
Mailing Address - Fax:404-705-8314
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:BLDG A, STE 560
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:404-705-8366
Practice Address - Fax:404-705-8314
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042408208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology