Provider Demographics
NPI:1124845078
Name:MARTINEZ, GERARDO
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S COLUMBIA DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4111
Mailing Address - Country:US
Mailing Address - Phone:806-206-5635
Mailing Address - Fax:
Practice Address - Street 1:406 S COLUMBIA DR UNIT B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4111
Practice Address - Country:US
Practice Address - Phone:806-206-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX984164163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse