Individual
DR. FREDERICK W MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
109 PROFESSIONAL PL, CARROLLTON, GA 30117-3862
(770) 834-0170
(770) 214-1546
Mailing address
119 AMBULANCE DR 202, CARROLLTON, GA 30117-3857
(770) 838-8710
(770) 838-8563
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
022595
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000223253A
PEACH STATE
GA
05
—
00223253A
—
GA
01
—
52150678001
BLUE CROSS BLUE SHIELD
—
Enumeration date
11/03/2006
Last updated
11/17/2015
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