Healthcare Provider Details

I. General information

NPI: 1013220292
Provider Name (Legal Business Name): MICHAEL JAMES MARTIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 HIGHWAY 45 BYP
JACKSON TN
38305-3618
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-8360
  • Fax: 731-882-5057
Mailing address:
  • Phone: 731-423-8697
  • Fax: 731-423-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2343
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: