Provider Demographics
NPI:1790775518
Name:MARTIN, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:MARTIN
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 1:1995 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3635
Mailing Address - Country:US
Mailing Address - Phone:901-476-7371
Mailing Address - Fax:
Practice Address - Street 1:1995 HIGHWAY 51 S
Practice Address - Street 2:SUITE 101
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3635
Practice Address - Country:US
Practice Address - Phone:901-476-7371
Practice Address - Fax:901-476-7372
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34810207Q00000X
KY34955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNBM6431011OtherDEA
TNG99688Medicare UPIN
TN3330526Medicare PIN