MEDICARE: MICHAEL JAMES MARTIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2343	TN

General Provider Information

NPI Number	:	1013220292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES MARTIN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38302-0400
Country	:	US
Telephone Number	:	731-423-8697
Fax Number	:	731-423-2073

Provider Business Practice Location Address
First Line	:	2859 HIGHWAY 45 BYP
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3618
Country	:	US
Telephone Number	:	731-660-8360
Fax Number	:	731-882-5057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	12/10/2025

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