Provider Demographics
NPI:1063543080
Name:MARTIN, JEANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY ROAD
Mailing Address - Street 2:SUITE 1-1100 (ATTENTION DENISE)
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:470-271-3421
Mailing Address - Fax:
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:STE. 2500
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-548-7909
Practice Address - Fax:706-548-7973
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060405207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA494634830AMedicaid
GA511I110791Medicare PIN