MEDICARE: TM MARTIN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	000239	GA

General Provider Information

NPI Number	:	1447376660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TM MARTIN INC

Provider Business Mailing Address
First Line	:	238 WESLEY CIR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2458
Country	:	US
Telephone Number	:	478-972-7755
Fax Number	:	478-743-5544

Provider Business Practice Location Address
First Line	:	238 WESLEY CIR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31204-2458
Country	:	US
Telephone Number	:	478-972-7755
Fax Number	:	478-743-5544

Authorized Official
Title or Position	:	OWNER
Name	:	TERENCE MALLOY MARTIN
Credential	:	PC-C
Telephone Number	:	478-743-4321

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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Directions to “TM MARTIN INC ” Practice Location

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