Provider Demographics
NPI:1083612295
Name:MARTHA JO CHRISTIAN MD PC
Entity Type:Organization
Organization Name:MARTHA JO CHRISTIAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-932-2497
Mailing Address - Street 1:1716 TEMPLE AVE N
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1309
Mailing Address - Country:US
Mailing Address - Phone:205-932-2497
Mailing Address - Fax:205-932-2539
Practice Address - Street 1:1716 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1309
Practice Address - Country:US
Practice Address - Phone:205-932-2497
Practice Address - Fax:205-932-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL99937OtherBC
AL99937OtherBC