Provider Demographics
NPI:1851405005
Name:MARTIN, ELIZABETH MCKELVEY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MCKELVEY
Last Name:MARTIN
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 1:2401 BROOKSTONE CENTRE PKWY BLDG 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4501
Mailing Address - Country:US
Mailing Address - Phone:706-256-0700
Mailing Address - Fax:866-390-9155
Practice Address - Street 1:2401 BROOKSTONE CENTRE PKWY BLDG 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4501
Practice Address - Country:US
Practice Address - Phone:706-256-0700
Practice Address - Fax:706-256-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00672218CMedicaid
GAF89449Medicare UPIN
GA00672218CMedicaid