=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578595831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAN C MARTIN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1008 DRUID PARK AVE STE 101
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30904-5848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-962-3642
-----------------------------------------------------
Fax | 770-962-3643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 PHILIP BLVD STE 140
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-8768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-962-3642
-----------------------------------------------------
Fax | 770-962-3643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 024031
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 024031
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------