Healthcare Provider Details

I. General information

NPI: 1770082620
Provider Name (Legal Business Name): MARTIN ASBERRY TURNER IV NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 LINDSEY LN
SAINT MARYS GA
31558-1636
US

IV. Provider business mailing address

51 LINDSEY LN
SAINT MARYS GA
31558-1636
US

V. Phone/Fax

Practice location:
  • Phone: 912-576-2344
  • Fax: 912-576-2349
Mailing address:
  • Phone: 912-576-2344
  • Fax: 912-576-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN239092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: