Provider Demographics
NPI:1639162654
Name:MARTELLI, MIGUEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:J
Last Name:MARTELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7 SAINT ANDREWS CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-6764
Mailing Address - Country:US
Mailing Address - Phone:912-267-0774
Mailing Address - Fax:912-267-9552
Practice Address - Street 1:7 SAINT ANDREWS CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6764
Practice Address - Country:US
Practice Address - Phone:912-267-0774
Practice Address - Fax:912-267-9552
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0324282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00415797AMedicaid
D91369Medicare UPIN
GA00415797AMedicaid