Provider Demographics
NPI:1861455479
Name:MARTIN, WILLIAM GEORGE III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GEORGE
Last Name:MARTIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-8640
Mailing Address - Fax:704-384-8650
Practice Address - Street 1:1640 CAMPUS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5284
Practice Address - Country:US
Practice Address - Phone:704-288-3961
Practice Address - Fax:704-225-0689
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9300750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954165Medicaid
SCN00750Medicaid
SCN00750Medicaid
NC8954165Medicaid
NC2194501EMedicare ID - Type Unspecified