Provider Demographics
NPI:1891875423
Name:MARTIN, GREGORY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:M
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:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:1498 JESSE JEWELL PKWY.
Practice Address - Street 2:STE. D
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3874
Practice Address - Country:US
Practice Address - Phone:678-450-4757
Practice Address - Fax:678-450-4758
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047801207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000956227DMedicaid
GA00956227AMedicaid
GA000956227DMedicaid
GA00956227AMedicaid
GA16BBBVFMedicare ID - Type Unspecified