Healthcare Provider Details

I. General information

NPI: 1730340787
Provider Name (Legal Business Name): ALEXANDRA MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 BLACKFORD ST
CHATTANOOGA TN
37403-1405
US

IV. Provider business mailing address

975 EAST THIRD STREET ATTN: PROVIDER ENROLLMENT
CHATTANOOGA TN
37403-2147
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-6405
  • Fax: 423-778-5522
Mailing address:
  • Phone: 423-778-3110
  • Fax: 423-778-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47843
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number47843
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: