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General NPI Number Information
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NPI Number | 1316946817
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Entity Type | Individual
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Provider Name | NICHOLAS ANTHONY PAUL MARTYAK MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 3651 WHEELER RD DEPARTMENT OF EMERGENCY MEDICINE
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City | AUGUSTA
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State | GA
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Zip | 30909-6521
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Country | US
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Telephone | 706-651-2369
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Fax | 706-651-2364
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Provider Business Mailing Address
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Address Line | 396 LAKESHORE DR NE
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City | ATLANTA
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State | GA
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Zip | 30307-1746
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Country | US
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Telephone | 912-228-2439
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 055268
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License Number State | GA
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