Provider Demographics
NPI:1609063239
Name:MARTINEZ, LAQUITA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAQUITA
Middle Name:RENEE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8319
Mailing Address - Country:US
Mailing Address - Phone:770-823-6803
Mailing Address - Fax:
Practice Address - Street 1:11975 MORRIS RD STE 310B
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4444
Practice Address - Country:US
Practice Address - Phone:678-261-7700
Practice Address - Fax:855-461-1697
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA67683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program