Provider Demographics
NPI:1972692150
Name:MARTIN, GEORGIA BETTINA (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:BETTINA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PITTSFIELD RD STE 12D
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2185
Mailing Address - Country:US
Mailing Address - Phone:413-344-1700
Mailing Address - Fax:413-728-8790
Practice Address - Street 1:55 PITTSFIELD RD STE 12D
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240
Practice Address - Country:US
Practice Address - Phone:413-344-1700
Practice Address - Fax:413-728-8790
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA252709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine