Provider Demographics
NPI:1194782771
Name:MARTIN, GREGORY D (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3338 COUNTRY CLUB RD STE M
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1045
Mailing Address - Country:US
Mailing Address - Phone:229-259-9666
Mailing Address - Fax:229-253-0064
Practice Address - Street 1:3338 COUNTRY CLUB RD STE M
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1045
Practice Address - Country:US
Practice Address - Phone:229-259-9666
Practice Address - Fax:229-253-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2024-06-25
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Provider Licenses
StateLicense IDTaxonomies
GA037611208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE89258Medicare UPIN