MEDICARE: CRAIG T. MARTINSON

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	122300000X	Dentist	DN011197	GA

General Provider Information

NPI Number	:	1710134960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG T. MARTINSON

Provider Business Mailing Address
First Line	:	1102 N COLUMBIA AVE
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-6807
Country	:	US
Telephone Number	:	912-564-7107
Fax Number	:	912-826-2432

Provider Business Practice Location Address
First Line	:	1102 N COLUMBIA AVE
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-6807
Country	:	US
Telephone Number	:	912-564-7107
Fax Number	:	912-826-2432

Authorized Official
Title or Position	:	CEO
Name	:	DR. CRAIG T. MARTINSON
Credential	:
Telephone Number	:	912-564-7107

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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