Wallace Ford Martin, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

026153 Issued in GA

Practice address

631 Professional Drive
Suite 300
Lawrenceville, GA 30046-3371

Phone

(770) 962-9977

Fax

(770) 339-9804

NPI assigned

Jul 7, 2005

Last updated

Sep 1, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gwinnett Surgical Associates, LLP

  • Surgery Physician
  • Lawrenceville, GA
  • NPI 1396049383
  Authorized official Same address or phone
• Wallace F. Martin, M.D.

  • Surgery Physician
  • Lawrenceville, GA
  • NPI 1124225065
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283299200000",
    "number": "1487651386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DRIVE",
            "address_2": "SUITE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463371",
            "telephone_number": "770-962-9977",
            "fax_number": "770-339-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DRIVE",
            "address_2": "SUITE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463371",
            "telephone_number": "770-962-9977",
            "fax_number": "770-339-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "WALLACE",
        "middle_name": "FORD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2010-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "026153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP1797",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00301914A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joanna Martin
• Juan Michelle Martin, DPT
• Linda K Martin, CRNA
• Naja Saleem Martin, PT, DPT
• Tamara Nichole Martin, LPN
• Zack Zeke Martin, M.D.
• Evelyn Martinez-Guy, PT, MS
• Mario Alberto Martinez Jr., NP
• Nadjeda Martinez, RN
• Nanisha Martinez

• Surgery Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.