Provider Demographics
NPI:1619004850
Name:MARTIN, ALISIA SHART (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISIA
Middle Name:SHART
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1538 THE GREENS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2499
Mailing Address - Country:US
Mailing Address - Phone:904-543-0161
Mailing Address - Fax:904-543-9172
Practice Address - Street 1:1538 THE GREENS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2499
Practice Address - Country:US
Practice Address - Phone:904-543-0161
Practice Address - Fax:904-543-9172
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00719722084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry