Provider Demographics
NPI:1508459694
Name:MARTIN, ERICA EVANS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:EVANS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 RIVER NORTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841
Mailing Address - Country:US
Mailing Address - Phone:912-661-5350
Mailing Address - Fax:
Practice Address - Street 1:1205 TOWN PARK LN
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3481
Practice Address - Country:US
Practice Address - Phone:706-868-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant