Healthcare Provider Details

I. General information

NPI: 1871555896
Provider Name (Legal Business Name): ERNEST C. MARTIN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W BELTLINE BLVD NORTH HILL PROFESSIONAL PARK
ANDERSON SC
29625-1505
US

IV. Provider business mailing address

309 WEST BELTLINE BLVD NORTH HILL PROFESSIONAL PARK
ANDERSON SC
29625-1505
US

V. Phone/Fax

Practice location:
  • Phone: 864-261-9506
  • Fax: 864-225-1134
Mailing address:
  • Phone: 864-261-9506
  • Fax: 864-226-8367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15740
License Number StateSC

VIII. Authorized Official

Name: DR. ERNEST CLEAGE MARTIN
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 864-261-9506