Provider Demographics
NPI:1225062300
Name:MARTIN, JAMES ALTON (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALTON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2600
Mailing Address - Country:US
Mailing Address - Phone:770-536-0977
Mailing Address - Fax:770-536-0976
Practice Address - Street 1:221 5TH AVE S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2600
Practice Address - Country:US
Practice Address - Phone:770-536-0977
Practice Address - Fax:770-536-0976
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002704103TC0700X
MTPSY-PSY-LIC-2505103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA490294748AMedicaid
GAQ03853Medicare UPIN