Healthcare Provider Details

I. General information

NPI: 1255513230
Provider Name (Legal Business Name): CARLA ARNETTE MARTIN D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9065 SANDIDGE CENTER CV. SUITE C
OLIVE BRANCH MS
38654
US

IV. Provider business mailing address

9065 SANDIDGE CENTER CV. SUITE C
OLIVE BRANCH MS
38654
US

V. Phone/Fax

Practice location:
  • Phone: 662-893-0533
  • Fax: 662-890-5676
Mailing address:
  • Phone: 662-893-0533
  • Fax: 662-890-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number80159
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: