Provider Demographics
NPI:1073550356
Name:ADOGU, MARTINE P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTINE
Middle Name:P
Last Name:ADOGU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1440 NORTH CHASE STREET
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601
Mailing Address - Country:US
Mailing Address - Phone:706-227-2110
Mailing Address - Fax:706-227-2113
Practice Address - Street 1:1440 N CHASE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1850
Practice Address - Country:US
Practice Address - Phone:706-227-2110
Practice Address - Fax:706-227-2116
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045379207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000802304AMedicaid
GA00802304BMedicaid
GA18BDGKLMedicare Oscar/Certification
GA00802304BMedicaid