Healthcare Provider Details

I. General information

NPI: 1740462886
Provider Name (Legal Business Name): JOSEPH ANTHONY MARTINO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 PEACHTREE RD NE STE 520-337
ATLANTA GA
30326-3287
US

IV. Provider business mailing address

3535 PEACHTREE RD NE STE 520-337
ATLANTA GA
30326-3287
US

V. Phone/Fax

Practice location:
  • Phone: 770-568-9187
  • Fax:
Mailing address:
  • Phone: 770-568-9187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number037023
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: