Healthcare Provider Details

I. General information

NPI: 1760821573
Provider Name (Legal Business Name): MARTIN ORTHOPAEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 MOUNT PELIA RD
MARTIN TN
38237-3812
US

IV. Provider business mailing address

764 WALNUT KNOLL LN
CORDOVA TN
38018-3113
US

V. Phone/Fax

Practice location:
  • Phone: 731-587-5900
  • Fax: 731-587-5908
Mailing address:
  • Phone: 901-756-5565
  • Fax: 901-756-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number13458
License Number StateTN

VIII. Authorized Official

Name: MALLORY ALEXANDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 901-756-5565