1679645022 NPI number — ZACHARY B MARTIN JR. M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679645022 NPI number — ZACHARY B MARTIN JR. M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MARTIN

Provider First Name:

ZACHARY

Provider Middle Name:

B

Provider Name Prefix Text:

Provider Name Suffix Text:

JR.

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1679645022

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/28/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 369

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ROME

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30162-0369

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

706-291-2077

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

255 W 5TH ST SW

Provider Second Line Business Practice Location Address:

SUITE 150

Provider Business Practice Location Address City Name:

ROME

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30165-2817

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

706-232-1545

Provider Business Practice Location Address Fax Number:

706-232-3819

Provider Enumeration Date:

11/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085B0100X , with the licence number:  035471 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085N0700X , with the licence number: 035471 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085N0904X , with the licence number: 035471 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085P0229X , with the licence number: 035471 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 035471 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2085R0203X , with the licence number: 035471 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0204X , with the licence number: 035471 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085U0001X , with the licence number: 035471 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 000494777A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 300034704 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 027195 . This is a "BCBS OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".