Kathy Martin-Wagner

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA000556 Issued in GA

Practice address

2899 Five Forks Trickum Rd
Lawrenceville, GA 30044-5803

Phone

(770) 316-9507

NPI assigned

Nov 13, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384300800000",
    "number": "1881024883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3460 HIGHLAND WAY",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300523501",
            "telephone_number": "770-316-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2899 FIVE FORKS TRICKUM RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445803",
            "telephone_number": "770-316-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN-WAGNER",
        "first_name": "KATHY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-13",
        "last_updated": "2013-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA000556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalia E. Marquis
• Gabriel Marrero, MD
• Lisa D Marrero, PAAA
• Arabia Lashaye Marshall, B.S.
• Olivia Roberta Marshall
• Christina Eckers Martin
• Jeremy Ward Martin, DC
• Joanna Martin
• Juan Michelle Martin, DPT
• Linda K Martin, CRNA

• Physical Therapy Assistant in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.