Provider Demographics
NPI:1861714420
Name:GEORGE MARTINEZ OFFICE OF INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:GEORGE MARTINEZ OFFICE OF INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. (PHYSICIAN)
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-452-5515
Mailing Address - Street 1:PO BOX 1415
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1415
Mailing Address - Country:US
Mailing Address - Phone:478-452-5515
Mailing Address - Fax:478-452-5517
Practice Address - Street 1:750 N. COBB ST.
Practice Address - Street 2:STE 120
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061
Practice Address - Country:US
Practice Address - Phone:478-452-5515
Practice Address - Fax:478-452-5517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE MARTINEZ OFFICE OF INTERNAL MEDICINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-24
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH52601Medicare UPIN