Provider Demographics
NPI:1629259643
Name:DAVID C MARTIN, M.D., P.A.
Entity Type:Organization
Organization Name:DAVID C MARTIN, M.D., P.A.
Other - Org Name:DOCTORS CENTER OF DADE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-657-8291
Mailing Address - Street 1:80 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-2867
Mailing Address - Country:US
Mailing Address - Phone:706-657-8291
Mailing Address - Fax:866-870-9256
Practice Address - Street 1:80 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2867
Practice Address - Country:US
Practice Address - Phone:706-657-8291
Practice Address - Fax:866-870-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA3153OtherMCR RAILROAD
DA3153OtherMCR RAILROAD