Provider Demographics
NPI:1003254954
Name:MARTIN, GUY WAYNE (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:GUY
Middle Name:WAYNE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-0016
Mailing Address - Country:US
Mailing Address - Phone:334-285-5544
Mailing Address - Fax:
Practice Address - Street 1:2588 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-3849
Practice Address - Country:US
Practice Address - Phone:334-285-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4078237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-50063OtherBC/BS OF ALABAMA