Healthcare Provider Details

I. General information

NPI: 1902809718
Provider Name (Legal Business Name): DAVID CHRISTOPHER MARTIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HOSPITAL DR STE A
MC KENZIE TN
38201-1649
US

IV. Provider business mailing address

PO BOX 700
SEWANEE TN
37375-0700
US

V. Phone/Fax

Practice location:
  • Phone: 731-352-7907
  • Fax: 731-352-4459
Mailing address:
  • Phone: 931-598-5648
  • Fax: 931-598-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1376
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: