Healthcare Provider Details

I. General information

NPI: 1902804537
Provider Name (Legal Business Name): JOHN PAUL MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 ANDREW ST
ONEIDA TN
37841-6296
US

IV. Provider business mailing address

PO BOX 4908
ONEIDA TN
37841-4908
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-3762
  • Fax: 423-569-4909
Mailing address:
  • Phone: 423-569-3762
  • Fax: 423-569-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26733
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26733
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: