Provider Demographics
NPI:1710038864
Name:MARTIN, APRIL HALL (PA)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:HALL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 KAHN DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2302
Mailing Address - Country:US
Mailing Address - Phone:910-738-5588
Mailing Address - Fax:
Practice Address - Street 1:5080 KAHN DR STE 120
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2302
Practice Address - Country:US
Practice Address - Phone:910-738-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104088363A00000X
GA005517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0765PAMedicaid
GA045884369BMedicaid
GAP00714519OtherRR MEDICARE
GA045884369AMedicaid
582203199-004OtherTRICARE
582203199-009OtherTRICARE
GA045884369BMedicaid