Provider Demographics
NPI:1124412234
Name:MARTIN, CHARLES C IV (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:MARTIN
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4458
Mailing Address - Country:US
Mailing Address - Phone:601-482-9224
Mailing Address - Fax:601-482-9223
Practice Address - Street 1:1001 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4458
Practice Address - Country:US
Practice Address - Phone:601-482-9224
Practice Address - Fax:601-482-9223
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24993207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology