Provider Demographics
NPI:1144809708
Name:MARTIN, CYDNI NOEL (PA)
Entity type:Individual
Prefix:
First Name:CYDNI
Middle Name:NOEL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 RIVER BOTTOM DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1300
Mailing Address - Country:US
Mailing Address - Phone:404-626-2593
Mailing Address - Fax:
Practice Address - Street 1:315 W PONCE DE LEON AVE STE 110
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2441
Practice Address - Country:US
Practice Address - Phone:404-537-2521
Practice Address - Fax:844-246-7292
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2025-05-14
Deactivation Date:2025-04-09
Deactivation Code:
Reactivation Date:2025-05-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant