Provider Demographics
NPI:1235526609
Name:MARTIN, AMELIA (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:EDMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:800 N JUSTICE ST BOX 16
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791
Mailing Address - Country:US
Mailing Address - Phone:828-694-8385
Mailing Address - Fax:828-694-7654
Practice Address - Street 1:2695 HENDERSONVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704
Practice Address - Country:US
Practice Address - Phone:828-694-8436
Practice Address - Fax:828-654-8152
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05702363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCN431C489Medicare PIN