Healthcare Provider Details

I. General information

NPI: 1225062300
Provider Name (Legal Business Name): JAMES ALTON MARTIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 5TH AVE S
GLASGOW MT
59230-2600
US

IV. Provider business mailing address

221 5TH AVE S
GLASGOW MT
59230-2600
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-0977
  • Fax: 770-536-0976
Mailing address:
  • Phone: 770-536-0977
  • Fax: 770-536-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-PSY-LIC-2505
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: