Provider Demographics
NPI:1427245133
Name:A. KEITH MARTIN, M.D., P.C.
Entity type:Organization
Organization Name:A. KEITH MARTIN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-750-8606
Mailing Address - Street 1:330 HOSPITAL DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3899
Mailing Address - Country:US
Mailing Address - Phone:478-750-8606
Mailing Address - Fax:478-750-0470
Practice Address - Street 1:330 HOSPITAL DR
Practice Address - Street 2:SUITE 315
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3899
Practice Address - Country:US
Practice Address - Phone:478-750-8606
Practice Address - Fax:478-750-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2890Medicare PIN