Provider Demographics
NPI:1275985533
Name:MARTINEZ GUTIERREZ, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
Last Name:MARTINEZ GUTIERREZ
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 1:2500 HOSPITAL BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4947
Mailing Address - Country:US
Mailing Address - Phone:770-664-9600
Mailing Address - Fax:770-664-9856
Practice Address - Street 1:2500 HOSPITAL BLVD STE 310
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4947
Practice Address - Country:US
Practice Address - Phone:770-664-9600
Practice Address - Fax:770-664-9856
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS90282084N0400X
MA268195390200000X
GA968322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program