Provider Demographics
NPI:1649237025
Name:MARTIN, CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3827 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141
Mailing Address - Country:US
Mailing Address - Phone:770-222-8900
Mailing Address - Fax:770-222-2757
Practice Address - Street 1:3827 JIMMY LEE SMITH PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:770-222-8900
Practice Address - Fax:770-222-2757
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00275571OtherMEDICARE RAILROAD PROV #
GA602583772FMedicaid
GA08BCBBCBMedicare UPIN
GAI20895Medicare UPIN