MEDICARE: MR. WILLIAM MARTIN MMS, PA-C

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	363A00000X	Physician Assistant	0010-05064	NC

General Provider Information

NPI Number	:	1982018958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM MARTIN MMS, PA-C

Provider Business Mailing Address
First Line	:	600 EAGLE RD
Second Line	:	APT 3F
City	:	GREENSBORO
State	:	NC
Zip	:	27407-5296
Country	:	US
Telephone Number	:	336-552-5861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 WILLARD DAIRY RD
Second Line	:	SUITE 301
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8351
Country	:	US
Telephone Number	:	336-884-3800
Fax Number	:

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

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	09/29/2021

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