Provider Demographics
NPI:1245292218
Name:MARTINEZ, ENRIQUE JESUS (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:JESUS
Last Name:MARTINEZ
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 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2209
Mailing Address - Country:US
Mailing Address - Phone:404-881-1094
Mailing Address - Fax:404-874-1249
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1620
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2209
Practice Address - Country:US
Practice Address - Phone:404-885-7701
Practice Address - Fax:404-885-7777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48441207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Not Answered207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00325531DMedicaid
GA00325531DMedicaid
GA11SCFPPMedicare ID - Type Unspecified