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General NPI Number Information
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NPI Number | 1265613277
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Entity Type | Organization
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Legal Business Name | M.J. MARTELLI, M.D.
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 7 SAINT ANDREWS CT
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City | BRUNSWICK
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State | GA
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Zip | 31520-6764
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Country | US
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Telephone | 912-267-0774
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Fax | 912-267-9552
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Provider Business Mailing Address
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Address Line | 7 SAINT ANDREWS CT
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City | BRUNSWICK
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State | GA
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Zip | 31520-6764
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Country | US
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Telephone | 912-267-0774
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Fax | 912-267-9552
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Authorized Official
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Title or Position | OWNER
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Name | MIGUEL JOSE MARTELLI
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Credential | M.D.
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Telephone | 912-267-0774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 032428
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License Number State | GA
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