Provider Demographics
NPI:1659352359
Name:NORRIS, MARTHA A (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:NORRIS
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 1:308 N PETERS RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2327
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:
Practice Address - Street 1:8 CADILLAC DR
Practice Address - Street 2:STE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5087
Practice Address - Country:US
Practice Address - Phone:615-376-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010790132085R0202X
TNMD0383482085R0202X
CAG680782085R0202X
OH35-0842382085R0202X
NC2010-004412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE68430Medicare UPIN
TN103I307394Medicare PIN
MIN91550001Medicare ID - Type Unspecified