MEDICARE: DR. CHARLES E MARTIN PHD

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	103TC0700X	Clinical Psychologist	P0000527	TN

General Provider Information

NPI Number	:	1740282631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E MARTIN PHD

Provider Business Mailing Address
First Line	:	111 CENTER PARK DR
Second Line	:	SUITE 1300
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2103
Country	:	US
Telephone Number	:	865-690-9998
Fax Number	:	865-691-7364

Provider Business Practice Location Address
First Line	:	111 CENTER PARK DR
Second Line	:	SUITE 1300
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2103
Country	:	US
Telephone Number	:	865-690-9998
Fax Number	:	865-691-7364

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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