Provider Demographics
NPI:1265789366
Name:MARTINEZ, EDUARDO (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 OLD JEFFERSON RD 200A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607
Mailing Address - Country:US
Mailing Address - Phone:706-549-5560
Mailing Address - Fax:706-543-2593
Practice Address - Street 1:3320 OLD JEFFERSON RD STE 200A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1478
Practice Address - Country:US
Practice Address - Phone:706-549-5560
Practice Address - Fax:706-543-2593
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2022-07-21
Deactivation Date:2020-06-01
Deactivation Code:
Reactivation Date:2020-06-11
Provider Licenses
StateLicense IDTaxonomies
GA078129207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty