Provider Demographics
NPI:1578604963
Name:MARTIN-WILLIE, ANDREA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:MARTIN-WILLIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-7261
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:300 STEAM PLANT RD STE 300
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3089
Practice Address - Country:US
Practice Address - Phone:615-451-9200
Practice Address - Fax:615-451-1246
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001100363A00000X
TN0000001100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I979227OtherMEDICARE PTAN
TN1507965Medicaid
TNQO2567Medicare UPIN
TN1507965Medicaid