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General NPI Number Information
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NPI Number | 1932443868
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Entity Type | Organization
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Legal Business Name | ANGELA M. MARTIN
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 10/10/2013
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Provider Practice Location Address
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Address Line | 200 BATTLE ST E SUITE B
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City | TALLADEGA
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State | AL
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Zip | 35160-2420
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Country | US
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Telephone | 256-368-9800
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Fax | 256-237-8400
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Provider Business Mailing Address
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Address Line | 304 E 4TH ST
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City | ANNISTON
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State | AL
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Zip | 36207-6012
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Country | US
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Telephone | 256-237-1184
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Fax | 256-237-8400
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGELA M. MARTIN
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Credential | MD
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Telephone | 256-368-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | AL13331
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License Number State | AL
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