Provider Demographics
NPI:1891981023
Name:MARTIN, HEATHER DAVIS (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAVIS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 NC HIGHWAY 68 S STE 111
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8382
Mailing Address - Country:US
Mailing Address - Phone:336-802-1111
Mailing Address - Fax:
Practice Address - Street 1:2754 NC HIGHWAY 68 S STE 111
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8382
Practice Address - Country:US
Practice Address - Phone:336-802-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002899363A00000X
TXPA05306363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant