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General NPI Number Information
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NPI Number | 1124412234
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Entity Type | Individual
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Provider Name | CHARLES C MARTIN IV MD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1001 14TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4458
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Country | US
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Telephone | 601-482-9224
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Fax | 601-482-9223
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Provider Business Mailing Address
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Address Line | PO BOX 649105
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City | DALLAS
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State | TX
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Zip | 75264-9105
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Country | US
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Telephone | 601-207-7093
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 24993
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 24993
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 24993
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License Number State | MS
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