Healthcare Provider Details

I. General information

NPI: 1457397101
Provider Name (Legal Business Name): LEON MARTIN JR. M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NORTH DECATUR ROAD
DECATUR GA
30033
US

IV. Provider business mailing address

4200 RIVER BOTTOM DR
NORCROSS GA
30092-1300
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-1849
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax: 510-879-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number026594
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number026594
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number026594
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number026594
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: