Healthcare Provider Details

I. General information

NPI: 1003801929
Provider Name (Legal Business Name): MARTIN E. OLSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N STATE OF FRANKLIN RD FL 1
JOHNSON CITY TN
37604-6056
US

IV. Provider business mailing address

PO BOX 699
MOUNTAIN HOME TN
37684-0699
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-7272
  • Fax: 423-439-7235
Mailing address:
  • Phone: 423-439-7272
  • Fax: 423-439-7235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD21208
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD21208
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: