Provider Demographics
NPI:1245290279
Name:MARTIN, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
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 1:34 UPPER RIVERDALE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:678-904-0094
Mailing Address - Fax:678-904-0098
Practice Address - Street 1:34 UPPER RIVERDALE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:678-904-0094
Practice Address - Fax:678-904-0098
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021757207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00285062A1Medicaid
GA00285062A1Medicaid