Basic Information
| Provider Information | |||||||||
| NPI: | 1063492742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | GUNTER | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6335 HOSPITAL PKWY | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300971549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047788311 | ||||||||
| FaxNumber: | 7704951585 | ||||||||
| Practice Location | |||||||||
| Address1: | 6325 HOSPITAL PKWY | ||||||||
| Address2: | EMORY JOHNS CREEK HOSP | ||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300975775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047788311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 11/16/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 1-035383 | AL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | 1035383 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 051507772 | 01 | AL | BC OF AL | OTHER | 1063492742 | 01 | AL | MEDICARE 510I430397 | OTHER | 009958585 | 05 | AL | MEDICAID |