Individual
MR. EARL T MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
218 QUARTERMAN ST, WAYCROSS, GA 31501
(912) 287-9140
(912) 287-1059
Mailing address
218 QUARTERMAN ST, WAYCROSS, GA 31501
(912) 287-0301
(912) 287-1568
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
028602
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000324156I
—
GA
05
—
10053757
—
GA
01
—
52407006
BLUE CROSS BLUE SHIELD GA
GA
01
—
GRP2665
EMPLOYER ID
GA
Enumeration date
08/11/2006
Last updated
07/21/2022
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