Healthcare Provider Details

I. General information

NPI: 1881672558
Provider Name (Legal Business Name): JONATHAN MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BLOUNT AVE SUITE 507
KNOXVILLE TN
37920
US

IV. Provider business mailing address

PO BOX 779
JOHNSON CITY TN
37605-0779
US

V. Phone/Fax

Practice location:
  • Phone: 865-525-0598
  • Fax: 865-525-0598
Mailing address:
  • Phone: 423-928-1145
  • Fax: 423-928-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37585
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37585
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: