1154450252 NPI number — C H MARTIN COMPANY

Table of content: (NPI 1154450252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154450252 NPI number — C H MARTIN COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C H MARTIN COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154450252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 MARIETTA ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30313-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-525-1533
Provider Business Mailing Address Fax Number:
478-738-0521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31021-9057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-275-9444
Provider Business Practice Location Address Fax Number:
478-275-1089
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILKES
Authorized Official First Name:
DORIS
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
478-224-1061

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00039476A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00339476B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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