Provider Demographics
NPI:1023249059
Name:MARTINEZ, CARMEN SOFIA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:SOFIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARMEN
Other - Middle Name:SOFIA
Other - Last Name:MARTINEZ VILLAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:445 WINN WAY
Mailing Address - Street 2:DEKALB COMMUNITY SERVICE BOARD
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1707
Mailing Address - Country:US
Mailing Address - Phone:404-508-7700
Mailing Address - Fax:
Practice Address - Street 1:445 WINN WAY
Practice Address - Street 2:DEKALB COMMUNITY SERVICE BOARD
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1707
Practice Address - Country:US
Practice Address - Phone:404-508-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-08
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA678262084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry