Healthcare Provider Details

I. General information

NPI: 1942959085
Provider Name (Legal Business Name): CAMDEN BLANE MARTIN MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 21ST AVE S MEDICAL CENTER NORTH - R1318
NASHVILLE TN
37232-5283
US

IV. Provider business mailing address

1161 21ST AVE S MEDICAL CENTER NORTH - R1318
NASHVILLE TN
37232-5283
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-3780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: