Active NPI
Paul Douglas Martin, DMD
- Dentist
- Marietta, GA
National Provider Identifier
1245750165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN015373
- Practice address
- 270 Cobb Pkwy S Ste 180
Marietta, GA 30060-6520 - Phone
- (352) 359-5325
- NPI assigned
- Jun 21, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN015373 | GA | Primary |
Addresses
Primary practice location
270 Cobb Pkwy S Ste 180
Marietta, GA 30060-6520
Mailing address
270 Cobb Pkwy S #180
Marietta, GA 30060
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170831003341 | GA | Order and Referring Only - Oral Surgery | 8729351481 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN015373 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498003200000",
"number": "1245750165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "270 COBB PKWY S #180",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "270 COBB PKWY S STE 180",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300606520",
"telephone_number": "352-359-5325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "PAUL",
"middle_name": "DOUGLAS",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-21",
"last_updated": "2017-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "GA",
"license": "DN015373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.