Healthcare Provider Details

I. General information

NPI: 1487679643
Provider Name (Legal Business Name): JOE ALAN MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 ANDERSON ST
BELTON SC
29627-2131
US

IV. Provider business mailing address

2000 E GREENVILLE ST SUITE 1600
ANDERSON SC
29621-1580
US

V. Phone/Fax

Practice location:
  • Phone: 864-226-9193
  • Fax: 864-716-6732
Mailing address:
  • Phone: 864-226-9193
  • Fax: 864-231-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2223
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: