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General NPI Number Information
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NPI Number | 1922209782
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Entity Type | Organization
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Legal Business Name | MARTIN ENTERPRISES,INC.
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1030 MAIN ST
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City | BEAN STATION
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State | TN
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Zip | 37708-4257
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Country | US
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Telephone | 865-993-4135
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Fax | 865-993-4108
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Provider Business Mailing Address
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Address Line | 1030 MAIN ST
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City | BEAN STATION
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State | TN
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Zip | 37708-4257
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Country | US
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Telephone | 865-993-4135
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Fax | 865-993-4108
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. WILLIAM L MARTIN
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Credential | D.O.
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Telephone | 865-993-4135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1101
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License Number State | TN
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