MEDICARE: C GREGORY MARTIN MD

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	207R00000X	Internal Medicine Physician	45652	MA
2	207R00000X	Internal Medicine Physician	MD51916	SC

General Provider Information

NPI Number	:	1023179504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C GREGORY MARTIN MD

Provider Business Mailing Address
First Line	:	4947 GREEN DOLPHIN WAY
Second Line	:
City	:	KIAWAH ISLAND
State	:	SC
Zip	:	29455-5420
Country	:	US
Telephone Number	:	978-618-4422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3226 MAYBANK HWY
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4858
Country	:	US
Telephone Number	:	843-266-9800
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/11/2024

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