Provider Demographics
NPI:1275673147
Name:MARTIN, CHANLEY MORGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANLEY
Middle Name:MORGAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY STE 340
Mailing Address - Street 2:DEPT. OF PSYCHIATRY, UNIVERSITY OF LOUISVILLE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1799
Mailing Address - Country:US
Mailing Address - Phone:502-852-5395
Mailing Address - Fax:
Practice Address - Street 1:501 E BROADWAY STE 340
Practice Address - Street 2:DEPT. OF PSYCHIATRY, UNIVERSITY OF LOUISVILLE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1799
Practice Address - Country:US
Practice Address - Phone:502-852-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR06492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry