Provider Demographics
NPI:1447238829
Name:CHRISTIAN, C MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:C MARTIN
Middle Name:
Last Name:CHRISTIAN
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:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1528
Mailing Address - Country:US
Mailing Address - Phone:478-272-1366
Mailing Address - Fax:478-275-2322
Practice Address - Street 1:104 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2565
Practice Address - Country:US
Practice Address - Phone:478-277-1255
Practice Address - Fax:478-304-1467
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038202207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000754641AMedicaid
GA1771155OtherUNITED HEALTHCARE
GA5111445OtherFIRST HEALTH
GA52450856-001OtherBCBS
GA7989248OtherAETNA
GA202I109493Medicare PIN
GA000754641AMedicaid
GA52450856-001OtherBCBS