Provider Demographics
NPI:1184369712
Name:MARTIN, JAMES WILLIAM JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-2913
Mailing Address - Country:US
Mailing Address - Phone:865-982-8557
Mailing Address - Fax:865-982-8599
Practice Address - Street 1:1617 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-2913
Practice Address - Country:US
Practice Address - Phone:865-982-8557
Practice Address - Fax:865-982-8599
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002087231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist