Provider Demographics
NPI:1568789576
Name:MARTIN, DAVID C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13375 JONES ST STE C
Mailing Address - Street 2:
Mailing Address - City:LAVONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30553-1147
Mailing Address - Country:US
Mailing Address - Phone:706-356-5439
Mailing Address - Fax:706-356-5897
Practice Address - Street 1:13375 JONES ST STE C
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-1147
Practice Address - Country:US
Practice Address - Phone:706-356-5439
Practice Address - Fax:706-356-5897
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA047486208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00860219CMedicaid
GA580633978009OtherATHENS AREA HEALTH PLAN SELECT
GA10056443OtherAMERIGROUP
GA0004103643OtherAETNA
GA309143OtherWELLCARE
GA582652628OtherTRICARE