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NPI Code Detail

MEDICARE: DR. NICHOLAS ANTHONY PAUL MARTYAK MD

MEDICARE: DR. NICHOLAS ANTHONY PAUL MARTYAK MD
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
1207P00000XEmergency Medicine Physician055268GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1345608OTHERWELLCARE OF GA
210062858OTHERAMERIGROUP
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41447352778OTHERNPI - CSRA EMERGENCY PHYS

General Provider Information

NPI Number : 1316946817
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLAS ANTHONY PAUL MARTYAK MD
Provider Business Mailing Address
First Line : 396 LAKESHORE DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30307-1746
Country : US
Telephone Number : 912-228-2439
Fax Number :
Provider Business Practice Location Address
First Line : 3651 WHEELER RD
Second Line : DEPARTMENT OF EMERGENCY MEDICINE
City : AUGUSTA
State : GA
Zip : 30909-6521
Country : US
Telephone Number : 706-651-2369
Fax Number : 706-651-2364
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 08/20/2013

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