Provider Demographics
NPI:1427042514
Name:MARTIN, ZACK ZEKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACK
Middle Name:ZEKE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:721 WELLNESS WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3304
Mailing Address - Country:US
Mailing Address - Phone:770-995-7989
Mailing Address - Fax:770-339-8646
Practice Address - Street 1:721 WELLNESS WAY
Practice Address - Street 2:STE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-995-7989
Practice Address - Fax:770-339-8646
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA029348207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA29-07010OtherUNITED HEALTHCARE
GA1591576OtherCIGNA PPO
GA582061514002OtherPRUDENTIAL
GA4083744OtherMANAGE CARE
GA0793OtherPROMINA
GA0793OtherONE HEALTH
GA100011951OtherRAIL ROAD MEDICARE
GA52237427OtherBLUE CROSS BLUE SHIELD
GA00340205AMedicaid
GA100011951OtherRAIL ROAD MEDICARE