Basic Information
| Provider Information | |||||||||
| NPI: | 1700103868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | CAMERON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5671 PEACHTREE DUNWOODY RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303425005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788437001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5671 PEACHTREE DUNWOODY RD STE 520 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788437001 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 80443 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RA0001X | MD60636162 | WA | N | 207RC0000X | MD60636162 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RA0001X | 82851 | GA | Y |
No ID Information.