Basic Information
| Provider Information | |||||||||
| NPI: | 1073059531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BABAYEV | ||||||||
| FirstName: | MARTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5038 WICKFORD DR | ||||||||
| Address2: | |||||||||
| City: | PEACHTREE CORNERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300962405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164697110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 UPPER RIVERDALE ROAD | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709918000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2017 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN241922 | GA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 39693 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.