Provider Demographics
NPI:1346251121
Name:MARTIN, WILLIAM DARRELL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DARRELL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1279 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4552
Mailing Address - Country:US
Mailing Address - Phone:770-991-2200
Mailing Address - Fax:770-991-1341
Practice Address - Street 1:1279 HIGHWAY 54 W
Practice Address - Street 2:SUITE 220
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4552
Practice Address - Country:US
Practice Address - Phone:770-991-2200
Practice Address - Fax:770-991-1341
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA024841207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00280849CMedicaid
GAD46028Medicare UPIN
GA00280849CMedicaid