Provider Demographics
NPI:1316946817
Name:MARTYAK, NICHOLAS ANTHONY PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANTHONY PAUL
Last Name:MARTYAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:396 LAKESHORE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1746
Mailing Address - Country:US
Mailing Address - Phone:912-228-2439
Mailing Address - Fax:
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-651-2369
Practice Address - Fax:706-651-2364
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA055268207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
345608OtherWELLCARE OF GA
10062858OtherAMERIGROUP
GA057308333AMedicaid
1447352778OtherNPI - CSRA EMERGENCY PHYS