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General NPI Number Information
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NPI Number | 1982480687
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Entity Type | Individual
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Provider Name | DEMETRIC MARTIN
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Gender | Female
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 736 COUNTY ROAD 39
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City | VOSSBURG
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State | MS
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Zip | 39366-5445
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Country | US
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Telephone | 601-466-0163
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 83
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City | VOSSBURG
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State | MS
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Zip | 39366-0083
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Country | US
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Telephone |
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | MS
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