MEDICARE: JOSEPH H. MARTIN, JR., MD, LLC

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	207R00000X	Internal Medicine Physician	025795	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110198450	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5225070003	OTHER	GA	BLUE CROSS BLUE SHIELD OF GA

General Provider Information

NPI Number	:	1700154093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH H. MARTIN, JR., MD, LLC

Provider Business Mailing Address
First Line	:	PO BOX 54306
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-0306
Country	:	US
Telephone Number	:	404-526-9111
Fax Number	:	404-526-9053

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE STE 1420
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2241
Country	:	US
Telephone Number	:	404-526-9111
Fax Number	:	404-526-9053

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	JOSEPH H MARTIN JR.
Credential	:	MD
Telephone Number	:	404-526-9111

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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