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General NPI Number Information
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NPI Number | 1023049509
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Entity Type | Individual
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Provider Name | ALAN P MARTIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 100 GROSS CRESCENT CIR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3643
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Country | US
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Telephone | 706-858-2000
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Fax | 865-291-3228
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Provider Business Mailing Address
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Address Line | PO BOX 634909
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City | CINCINNATI
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State | OH
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Zip | 45263-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003258
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License Number State | GA
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