Healthcare Provider Details

I. General information

NPI: 1013193374
Provider Name (Legal Business Name): ANGELA M. MARTIN, M.D. F.A.A.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 10TH ST
ANNISTON AL
36207-5706
US

IV. Provider business mailing address

222 E 10TH ST
ANNISTON AL
36207-5706
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-1184
  • Fax: 256-237-8400
Mailing address:
  • Phone: 256-237-1184
  • Fax: 256-237-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13331
License Number StateAL

VIII. Authorized Official

Name: ANGELA M. MARTIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 256-237-1184