Healthcare Provider Details

I. General information

NPI: 1922297175
Provider Name (Legal Business Name): DR. MARTIN'S OB-GYN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 EMERALD AVE SUITE 801
KNOXVILLE TN
37917-4502
US

IV. Provider business mailing address

831 BAYLOR CIR
KNOXVILLE TN
37923-7011
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-6721
  • Fax: 865-546-6724
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number38553
License Number StateTN

VIII. Authorized Official

Name: DUY-THU PD MARTIN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 865-546-6721