MEDICARE: MR. CHARLES BRENT MARTIN M.S., BCBA

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	103K00000X	Behavior Analyst	1-10-6993	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649640053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES BRENT MARTIN M.S., BCBA

Provider Business Mailing Address
First Line	:	1120 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2439
Country	:	US
Telephone Number	:	850-215-6770
Fax Number	:	850-665-0123

Provider Business Practice Location Address
First Line	:	1120 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2439
Country	:	US
Telephone Number	:	850-215-6770
Fax Number	:	850-665-0123

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

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	04/15/2025

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