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Melissa Kathleen Martin

Internal Medicine

Allopathic & Osteopathic Physicians

1500 Oglethorpe Ave, Suite 2500, Athens, GA 30606-2179

PECOS Enrollment

This provider is enrolled in PECOS as MELISSA MARTIN.

Based on the most recent information from CMS, provider Melissa Kathleen Martin is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1962430090
Provider Type
Individual
Full Name
Martin, Melissa Kathleen
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
6/29/2006
Last Updated
6/22/2010

Contact Information

Practice Location

1500 Oglethorpe Ave, Suite 2500, Athens, GA 30606-2179

(706) 548-7909

(706) 543-6091

Mailing Location

1500 Oglethorpe Ave, Suite 2500, Athens, GA 30606-2179

(706) 548-7909

(706) 543-6091

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 058071 Georgia
Code 208000000X	Description Pediatrics Allopathic & Osteopathic Physicians	License 058071 Georgia

Provider Identifiers

ID	Description	Issuer
ID 747573398A	Description Medicaid	Issuer Unlisted Georgia
ID 747573398B	Description Medicaid	Issuer Unlisted Georgia

Melissa Kathleen Martin

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Tschepikow, Marla S

Taylor, Brandon J

Nelson, Michael E

Onweni-Eze, Maureen Ugochi

Gowda, Narayana

Walters, Keith Nesta

St. Mary'S Medical Group, Inc.

Crites, Gerald E

Smith, Elizabeth D

Van Rijn, Kilian