Healthcare Provider Details

I. General information

NPI: 1134790512
Provider Name (Legal Business Name): ZACHARY WILLIAM MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N CHURCH ST
GREENSBORO NC
27405-5671
US

IV. Provider business mailing address

2101 N CHURCH ST
GREENSBORO NC
27405-5671
US

V. Phone/Fax

Practice location:
  • Phone: 704-780-4271
  • Fax:
Mailing address:
  • Phone: 704-780-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: