Healthcare Provider Details

I. General information

NPI: 1295985992
Provider Name (Legal Business Name): MARTIN FAMILY HEALTHCARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 10/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MARKET ST.
RED BOILING SPRINGS TN
37150
US

IV. Provider business mailing address

P.O. BOX 425
RED BOILING SPRINGS TN
37150
US

V. Phone/Fax

Practice location:
  • Phone: 615-699-4035
  • Fax: 615-699-4055
Mailing address:
  • Phone: 615-699-4035
  • Fax: 615-699-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0000001100
License Number StateTN

VIII. Authorized Official

Name: MRS. ANDREA L. MARTIN
Title or Position: PHYSICIAN ASST./OWNER
Credential: PA-C
Phone: 615-699-4035