Provider Demographics
NPI:1578570321
Name:MARTIN, RANDOLPH P (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:P
Last Name:MARTIN
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 1:275 COLLIER ROAD, NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1740
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:404-351-5983
Practice Address - Street 1:275 COLLIER ROAD, NW
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1740
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:404-351-5983
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013228207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000408163CMedicaid
GA000408163CMedicaid
GA202I061965Medicare PIN
GAC04073Medicare UPIN