Provider Demographics
NPI:1083648596
Name:MARTIN, GARRETT CLARK (MD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:CLARK
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5354 REYNOLDS ST
Mailing Address - Street 2:SUITE 424
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-819-5999
Mailing Address - Fax:912-819-5980
Practice Address - Street 1:13901 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2720
Practice Address - Country:US
Practice Address - Phone:313-822-0900
Practice Address - Fax:313-822-0950
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67934208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4670740Medicaid
MIN30150015Medicare ID - Type UnspecifiedMEDICARE
MII24054Medicare UPIN