Active NPI
Manuel Martinez
- Psychiatry Physician
- Marietta, GA
National Provider Identifier
1689630022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 024757
- Practice address
- 2540 Windy Hill Rd SE
Marietta, GA 30067-8605 - Phone
- (770) 644-1570
- Fax
- (770) 644-1576
- NPI assigned
- Apr 25, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 024757 | GA | Primary |
Addresses
Primary practice location
2540 Windy Hill Rd SE
Marietta, GA 30067-8605
Mailing address
2540 Windy Hill Rd SE
Marietta, GA 30067-8605
Other practice location 1
1915 Eisenhower Dr
Savannah, GA 31406-5027
Phone (912) 356-2011
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 024757 | Other | GA | LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mmartinez497336@directwellstar.org | Health Information Exchange (HIE) |
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
Interoperability endpoints
- manuel.martinez@hca5.eclinicaldirectplus.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668384000000",
"number": "1689630022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2540 WINDY HILL RD SE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300678605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2540 WINDY HILL RD SE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300678605",
"telephone_number": "770-644-1570",
"fax_number": "770-644-1576"
}
],
"practiceLocations": [
{
"address_1": "1915 Eisenhower Dr",
"address_purpose": "LOCATION",
"city": "Savannah",
"state": "GA",
"postal_code": "314065027",
"country_code": "US",
"telephone_number": "912-356-2011",
"fax_number": "912-351-3538",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARTINEZ",
"first_name": "MANUEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-25",
"last_updated": "2022-11-14",
"certification_date": "2022-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "024757",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "024757",
"state": "GA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mmartinez497336@directwellstar.org",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"address_1": "2540 Windy Hill Rd SE",
"city": "Marietta",
"state": "GA",
"country_code": "US",
"postal_code": "300678605",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.