Wallace F. Martin, M.D.

LBN: Wallace F. Martin, M.D.
Wallace F. Martin, M.D. is an health care organization with primary practice located at 631 Professional Dr Suite 300, Lawrenceville GA 30046-3371. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as the primary health care specialty. Wallace F. Martin, M.D. can be contacted via phone (770) 962-9977, or through Martin, Wallace Ford via phone (770) 962-9977.

Contact Information

Primary practice address
631 Professional Dr Suite 300 Lawrenceville GA 30046-3371
Phone: (770) 962-9977
Fax: (770) 339-9804
Website:
Map and Directions
Authorized official contact:
Name: Martin, Wallace Ford Doctor of Medicine (MD)
Phone: (770) 962-9977

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 026153 Georgia

Profile Details

NPI number 1124225065
LBN Legal business name Wallace F. Martin, M.D.
DBA Doing business as
Authorized official Martin, Wallace Ford Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 2nd, 2007
Last updated Sep 1st, 2010 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124225065 NPPES
Georgia Other GRP1797 MEDICARE GROUP#
Georgia MEDICAID 00301914A MEDICARE GROUP#

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