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General NPI Number Information
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NPI Number | 1497334130
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Entity Type | Individual
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Provider Name | THOMAS CLAYTON MARTIN JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 30983 HIGHWAY 441 S
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City | COMMERCE
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State | GA
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Zip | 30529-6655
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Country | US
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Telephone | 706-335-7818
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Fax |
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Provider Business Mailing Address
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Address Line | 3180 MATHIESON DR NE UNIT 902
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City | ATLANTA
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State | GA
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Zip | 30305-1871
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Country | US
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Telephone | 770-546-8375
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH024684
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License Number State | GA
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