Healthcare Provider Details

I. General information

NPI: 1912005224
Provider Name (Legal Business Name): HELEN S MARTIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 WINDSOR CT
HICKORY NC
28602-8985
US

IV. Provider business mailing address

2797 NC 55 HWY
CARY NC
27519-6206
US

V. Phone/Fax

Practice location:
  • Phone: 954-592-1740
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax: 401-652-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0913
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04455
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: