Marthalene Logan

NPI #1700289048 in Bethlehem, Georgia

Provider Information

NPI Number: 1700289048
Entity Type: Individual
Name: Marthalene Logan
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Oct 1, 2014
Last Updated: Oct 1, 2014

Practice Location

Address: 4514 YORKTOWN DR
City: Bethlehem
State: Georgia
ZIP Code: 30620-4826
Phone: (678) 635-5463

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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