Provider Demographics
NPI:1164503827
Name:HOLLY D MARTZ MD PC
Entity Type:Organization
Organization Name:HOLLY D MARTZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:DYAN
Authorized Official - Last Name:MARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-860-2221
Mailing Address - Street 1:3443 DICKERSON PIKE
Mailing Address - Street 2:STE 380
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2519
Mailing Address - Country:US
Mailing Address - Phone:615-860-2221
Mailing Address - Fax:615-860-9560
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:STE 380
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-860-2221
Practice Address - Fax:615-860-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734940Medicaid
TN1164503827OtherNPI
TN3734940Medicaid
TN3734940Medicare PIN