Healthcare Provider Details

I. General information

NPI: 1760156871
Provider Name (Legal Business Name): KAITLYN MARTIN, DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SHIRLEY DR
WINCHESTER TN
37398-2256
US

IV. Provider business mailing address

161 SHIRLEY DR
WINCHESTER TN
37398-2256
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-0450
  • Fax: 931-962-0470
Mailing address:
  • Phone: 931-962-0450
  • Fax: 931-962-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAITLYN MARTIN
Title or Position: OWNER
Credential: DO
Phone: 931-962-0405