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General NPI Number Information
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NPI Number | 1508860420
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Entity Type | Individual
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Provider Name | JEANNE R. MARTIN PAC
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Gender | Female
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 526 RICHLAND AVE W
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City | AIKEN
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State | SC
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Zip | 29801-3828
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Country | US
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Telephone | 803-648-3130
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Fax | 803-648-9860
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Provider Business Mailing Address
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Address Line | PO BOX 1132
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City | AIKEN
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State | SC
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Zip | 29802-1132
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Country | US
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Telephone | 803-648-3130
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Fax | 803-648-9860
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 423
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License Number State | SC
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