Healthcare Provider Details

I. General information

NPI: 1699877324
Provider Name (Legal Business Name): MARTIN DAVID JEFFRIES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E HIGH ST STE 201
CHARLOTTESVILLE VA
22902-4850
US

IV. Provider business mailing address

300 E HOSPITAL ROAD OBGYN DEPARTMENT
FT. GORDON GA
30905-3089
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-2870
  • Fax:
Mailing address:
  • Phone: 706-787-7445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number026875
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number026875
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number026875
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: