Provider Demographics
NPI:1477511053
Name:CARMICHAEL, MARTIN D (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:D
Last Name:CARMICHAEL
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 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6827
Mailing Address - Fax:843-234-6990
Practice Address - Street 1:51 ELEVENTH AVENUE
Practice Address - Street 2:
Practice Address - City:AYNOR
Practice Address - State:SC
Practice Address - Zip Code:29511-3942
Practice Address - Country:US
Practice Address - Phone:843-358-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC120737Medicaid
SCGP5462OtherMEDICAID GROUP
SC7844OtherMEDICARE GROUP PTAN
SC120737Medicaid
SCGP4505Medicaid
SCD055928178OtherMEDICARE PTAN
SC8178OtherMEDICARE
SC120737Medicaid
SCGP5462OtherMEDICAID GROUP
SCD055929493Medicare PIN