Active NPI
Katelyn Martin
- Adult Mental Health Clinic/Center
- Tucker, GA
National Provider Identifier
1306547195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Mental Health Clinic/Center
- License
- APC008329
- Practice address
- 3754 Lavista Rd Ste 200
Tucker, GA 30084-5627 - Phone
- (678) 896-8246
- NPI assigned
- Mar 17, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Mental Health Clinic/Center | 261QM0850X | APC008329 | GA | Primary |
Addresses
Primary practice location
3754 Lavista Rd Ste 200
Tucker, GA 30084-5627
Mailing address
3754 Lavista Rd Ste 200
Tucker, GA 30084-5627
Phone (678) 896-8246
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APC008329 | GA | MD | Adult Mental Health Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679011200000",
"number": "1306547195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3754 LAVISTA RD STE 200",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845627",
"telephone_number": "678-896-8246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3754 LAVISTA RD STE 200",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845627",
"telephone_number": "678-896-8246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KATELYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-17",
"last_updated": "2023-03-17",
"certification_date": "2022-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "261QM0850X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Mental Health",
"state": "GA",
"license": "APC008329",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.