Healthcare Provider Details

I. General information

NPI: 1306396437
Provider Name (Legal Business Name): MARTIN GUERIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

PO BOX 749748
ATLANTA GA
30374-9748
US

V. Phone/Fax

Practice location:
  • Phone: 423-206-5040
  • Fax: 423-206-5041
Mailing address:
  • Phone: 423-495-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number39121
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11006935
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA163046
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: