Provider Demographics
NPI:1871913129
Name:MARTIN-BROWN, LEISEL SAMANTHA (MD)
Entity type:Individual
Prefix:
First Name:LEISEL
Middle Name:SAMANTHA
Last Name:MARTIN-BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEISEL
Other - Middle Name:SAMANTHA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3225 SHALLOWFORD RD STE 300B
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1299
Mailing Address - Country:US
Mailing Address - Phone:678-734-9293
Mailing Address - Fax:
Practice Address - Street 1:3225 SHALLOWFORD RD STE 300B
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1299
Practice Address - Country:US
Practice Address - Phone:678-734-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA834572084P0804X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program