Healthcare Provider Details

I. General information

NPI: 1922209782
Provider Name (Legal Business Name): MARTIN ENTERPRISES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MAIN ST
BEAN STATION TN
37708-4257
US

IV. Provider business mailing address

1030 MAIN ST
BEAN STATION TN
37708-4257
US

V. Phone/Fax

Practice location:
  • Phone: 865-993-4135
  • Fax: 865-993-4108
Mailing address:
  • Phone: 865-993-4135
  • Fax: 865-993-4108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1101
License Number StateTN

VIII. Authorized Official

Name: DR. WILLIAM L MARTIN
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 865-993-4135