Provider Demographics
NPI:1437388055
Name:MARTIN, SCOTT CHASLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHASLEY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 CLINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5227
Mailing Address - Country:US
Mailing Address - Phone:601-924-7994
Mailing Address - Fax:601-924-7671
Practice Address - Street 1:732 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5227
Practice Address - Country:US
Practice Address - Phone:601-924-7994
Practice Address - Fax:601-924-7671
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine