MEDICARE: JOHN C. MARTIN D.M.D, M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0008367	GA

General Provider Information

NPI Number	:	1194878900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN C. MARTIN D.M.D, M.S.

Provider Business Mailing Address
First Line	:	4011 ATLANTA HWY
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-2212
Country	:	US
Telephone Number	:	706-353-1700
Fax Number	:	706-353-1774

Provider Business Practice Location Address
First Line	:	4011 ATLANTA HWY
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-2212
Country	:	US
Telephone Number	:	706-353-1700
Fax Number	:	706-353-1774

Authorized Official
Title or Position	:	DOCTOR OWNER
Name	:	DR. JOHN C MARTIN
Credential	:	D.M.D., M.S.
Telephone Number	:	706-353-1700

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/22/2020

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