Organization
CHILD AND ADOLESCENT MEDICAL PROVIDERS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID C MARTIN MD (CEO)
(706) 356-5439
Entity
Organization
Contact information
Practice address
13375 JONES ST STE C, LAVONIA, GA 30553-1147
(706) 356-5439
(706) 356-5897
Mailing address
13375 JONES ST STE C, LAVONIA, GA 30553-1147
(706) 356-5439
(706) 356-5897
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
047486
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00860219C
—
GA
05
—
10056443
—
GA
05
—
309143
—
GA
01
—
52768660
BCBS PIN#
GA
05
—
85002622G
—
GA
Enumeration date
12/29/2006
Last updated
08/22/2020
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