Healthcare Provider Details

I. General information

NPI: 1508463365
Provider Name (Legal Business Name): LOGAN CURRAN MARTIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 DINAH SHORE BLVD
WINCHESTER TN
37398-1107
US

IV. Provider business mailing address

1700 SUMMER ST APT C92
MANCHESTER TN
37355-2396
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-6669
  • Fax: 931-967-6606
Mailing address:
  • Phone: 615-587-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4357
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: