Provider Demographics
NPI:1982018958
Name:MARTIN, WILLIAM (MMS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EAGLE RD
Mailing Address - Street 2:APT 3F
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-5296
Mailing Address - Country:US
Mailing Address - Phone:336-552-5861
Mailing Address - Fax:
Practice Address - Street 1:2630 WILLARD DAIRY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8351
Practice Address - Country:US
Practice Address - Phone:336-884-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05064363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant