Healthcare Provider Details

I. General information

NPI: 1730182122
Provider Name (Legal Business Name): CATHERINE LYNN MARTIN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 UNIVERSITY AVE
SEWANEE TN
37375-2336
US

IV. Provider business mailing address

515 CUMBERLAND ST W
COWAN TN
37318-3107
US

V. Phone/Fax

Practice location:
  • Phone: 931-598-5648
  • Fax: 931-598-9984
Mailing address:
  • Phone: 931-598-5648
  • Fax: 931-598-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1155
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: