Provider Demographics
NPI:1598558116
Name:MARTIN, MILISSA MICHELLE (PCT,CNA)
Entity type:Individual
Prefix:MS
First Name:MILISSA
Middle Name:MICHELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PCT,CNA
Other - Prefix:
Other - First Name:MILISSA
Other - Middle Name:MICHELLE
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCH
Mailing Address - Street 1:55 THUNDER RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-4952
Mailing Address - Country:US
Mailing Address - Phone:706-973-2544
Mailing Address - Fax:
Practice Address - Street 1:55 THUNDER RD
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-4952
Practice Address - Country:US
Practice Address - Phone:706-973-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health