MEDICARE: ANGELA M. MARTIN

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	261QR1300X	Rural Health Clinic/Center	AL13331	AL

General Provider Information

NPI Number	:	1932443868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELA M. MARTIN

Provider Business Mailing Address
First Line	:	304 E 4TH ST
Second Line	:
City	:	ANNISTON
State	:	AL
Zip	:	36207-6012
Country	:	US
Telephone Number	:	256-237-1184
Fax Number	:	256-237-8400

Provider Business Practice Location Address
First Line	:	200 BATTLE ST E
Second Line	:	SUITE B
City	:	TALLADEGA
State	:	AL
Zip	:	35160-2420
Country	:	US
Telephone Number	:	256-368-9800
Fax Number	:	256-237-8400

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANGELA M. MARTIN
Credential	:	MD
Telephone Number	:	256-368-9800

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	10/10/2013

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