Martin Mandela Baxter, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

98019 Issued in GA

Practice address

2084 Headland Dr
East Point, GA 30344-2135

Phone

(404) 965-5691

Fax

(404) 698-1478

NPI assigned

May 8, 2021

Reactivated

Jun 9, 2022

Sex

Male

Sole proprietor

No

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

• PMR Georgia Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1609329630

  GA

  Medicare reassignment NPD
• Jencare Neighborhood Medical Center West End, LLC

  • Specialist
  • Atlanta, GA
  • NPI 1366783524
  NPD (past)

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 6, 2024.

{
    "created_epoch": "1620432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1609450485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2084 HEADLAND DR",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303442135",
            "telephone_number": "404-965-5691",
            "fax_number": "404-698-1478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2084 HEADLAND DR",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303442135",
            "telephone_number": "404-965-5691",
            "fax_number": "404-698-1478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAXTER",
        "first_name": "MARTIN",
        "middle_name": "MANDELA",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-08",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "deactivation_date": "2022-05-06",
        "reactivation_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "98019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carli Barbo
• Barclay Light and Wellness LLC
• Shanicqua Barnes, CRANIALPROSTHESISSPE
• Andrea Barton, MA, CCC-SLP
• Faraz Bassari, D.C.
• Baze Pharmacy LLC
• Baze Specialty Pharmacy, LLC
• Demetric Bazi
• Beal Wellness LLC
• Ra'Jae Belton

• All providers in East Point, GA
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.

Verify at the official NPI Registry.