Provider Demographics
NPI:1386728459
Name:MARTIN, RALPH HENRY (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:HENRY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:H
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO PC
Mailing Address - Street 1:4467 LEMON STREET
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101
Mailing Address - Country:US
Mailing Address - Phone:770-917-0948
Mailing Address - Fax:770-917-8666
Practice Address - Street 1:4467 LEMON STREET
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101
Practice Address - Country:US
Practice Address - Phone:770-917-0948
Practice Address - Fax:770-917-8666
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027607207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D40558Medicare UPIN