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General NPI Number Information
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NPI Number | 1508463365
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Entity Type | Individual
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Provider Name | LOGAN CURRAN MARTIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 1211 DINAH SHORE BLVD
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City | WINCHESTER
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State | TN
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Zip | 37398-1107
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Country | US
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Telephone | 931-967-6669
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Fax | 931-967-6606
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Provider Business Mailing Address
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Address Line | 1700 SUMMER ST APT C92
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City | MANCHESTER
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State | TN
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Zip | 37355-2396
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Country | US
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Telephone | 615-587-1436
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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 | 4357
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License Number State | TN
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