Provider Demographics
NPI:1417178740
Name:JAMES B. MARTIN M.D. LLC
Entity Type:Organization
Organization Name:JAMES B. MARTIN M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-875-3097
Mailing Address - Street 1:1103 HANLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3108
Mailing Address - Country:US
Mailing Address - Phone:228-875-3097
Mailing Address - Fax:228-875-3299
Practice Address - Street 1:1103 HANLEY RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3108
Practice Address - Country:US
Practice Address - Phone:228-875-3097
Practice Address - Fax:228-875-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS50013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy