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Individual

DR. ZACK ZEKE MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
721 WELLNESS WAY, STE 100, LAWRENCEVILLE, GA 30046
(770) 995-7989
(770) 339-8646
Mailing address
721 WELLNESS WAY, STE 100, LAWRENCEVILLE, GA 30046-3304
(770) 995-7989
(770) 339-8646

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
029348
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00340205A
GA
01
0793
PROMINA
GA
01
100011951
RAIL ROAD MEDICARE
GA
01
1591576
CIGNA PPO
GA
01
29-07010
UNITED HEALTHCARE
GA
01
4083744
MANAGE CARE
GA
01
52237427
BLUE CROSS BLUE SHIELD
GA
01
582061514002
PRUDENTIAL
GA
Enumeration date
09/06/2005
Last updated
01/25/2013
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