Healthcare Provider Details

I. General information

NPI: 1053317149
Provider Name (Legal Business Name): DAVID S MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MEDICAL CENTER PARKWAY
MURFREESBORO TN
37129
US

IV. Provider business mailing address

820 MEDICAL CENTER PARKWAY
MURFREESBORO TN
37129
US

V. Phone/Fax

Practice location:
  • Phone: 615-907-1015
  • Fax: 615-907-6692
Mailing address:
  • Phone: 615-907-1015
  • Fax: 615-907-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number26589
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number26589
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: