Provider Demographics
NPI:1174768220
Name:MARTIN, DONNA BAGGETT (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:BAGGETT
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2142 W BROAD ST
Mailing Address - Street 2:BLDG 100, STE 200
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3506
Mailing Address - Country:US
Mailing Address - Phone:706-548-6881
Mailing Address - Fax:706-546-0821
Practice Address - Street 1:2142 W BROAD ST
Practice Address - Street 2:BLDG 100, STE 200
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3506
Practice Address - Country:US
Practice Address - Phone:706-548-6881
Practice Address - Fax:706-546-0821
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN105892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003105864AMedicaid