Healthcare Provider Details

I. General information

NPI: 1588622641
Provider Name (Legal Business Name): JAMES F MARTIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 SPEARS CREEK CHURCH RD SUITE 102
ELGIN SC
29045-9316
US

IV. Provider business mailing address

566 SPEARS CREEK CHURCH RD SUITE 102
ELGIN SC
29045-9316
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-6201
  • Fax:
Mailing address:
  • Phone: 803-788-6201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13700
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: