Provider Demographics
NPI:1497716070
Name:MARTIN, CHRISTOPHER GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:GEORGE
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 1:146 W PARK DR
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3824
Mailing Address - Country:US
Mailing Address - Phone:423-246-3220
Mailing Address - Fax:423-246-3221
Practice Address - Street 1:146 W PARK DR
Practice Address - Street 2:SUITE 9B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3824
Practice Address - Country:US
Practice Address - Phone:423-246-3220
Practice Address - Fax:423-246-3221
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD264492080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3089781Medicaid
TN3089781Medicaid