Active NPI
David Michael Martin, MD
- Gastroenterology Physician
- Riverdale, GA
National Provider Identifier
1245290279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 021757
- Practice address
- 34 Upper Riverdale Road
Suite 201
Riverdale, GA 30274 - Phone
- (678) 904-0094
- Fax
- (678) 904-0098
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 021757 | GA | Primary |
Addresses
Primary practice location
34 Upper Riverdale Road
Suite 201
Riverdale, GA 30274
Mailing address
34 Upper Riverdale Road
Suite 201
Riverdale, GA 30274
Phone (678) 904-0094
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00285062A1 | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021757 | GA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1245290279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 UPPER RIVERDALE ROAD",
"address_2": "SUITE 201",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "30274",
"telephone_number": "678-904-0094",
"fax_number": "678-904-0098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 UPPER RIVERDALE ROAD",
"address_2": "SUITE 201",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "30274",
"telephone_number": "678-904-0094",
"fax_number": "678-904-0098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "DAVID",
"middle_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "GA",
"license": "021757",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00285062A1",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverdale, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.