Provider Demographics
NPI:1073507828
Name:MARTINEZ, GEORGE E (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28650
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-8650
Mailing Address - Country:US
Mailing Address - Phone:478-452-5515
Mailing Address - Fax:478-452-5517
Practice Address - Street 1:750 N COBB ST
Practice Address - Street 2:STE 120
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2390
Practice Address - Country:US
Practice Address - Phone:478-452-5515
Practice Address - Fax:478-452-5517
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00931664AMedicaid
GA11BDVDRMedicare ID - Type Unspecified
GA00931664AMedicaid