Provider Demographics
NPI:1710712336
Name:WHITE, MARTIKA N
Entity type:Individual
Prefix:
First Name:MARTIKA
Middle Name:N
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STEPHANIE DR
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31301-2545
Mailing Address - Country:US
Mailing Address - Phone:470-925-2905
Mailing Address - Fax:
Practice Address - Street 1:2451B US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3397
Practice Address - Country:US
Practice Address - Phone:470-925-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician