Provider Demographics
NPI:1437601549
Name:DEBORAH A MARTIN, MD, FACS
Entity Type:Organization
Organization Name:DEBORAH A MARTIN, MD, FACS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-844-2144
Mailing Address - Street 1:1400 NORTHSIDE FORSYTH DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7668
Mailing Address - Country:US
Mailing Address - Phone:770-844-2144
Mailing Address - Fax:770-844-2026
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR
Practice Address - Street 2:SUITE 340
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7668
Practice Address - Country:US
Practice Address - Phone:770-844-2144
Practice Address - Fax:770-844-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000405127CMedicaid
02BDBFGMedicare PIN
GAE64953Medicare UPIN