Provider Demographics
NPI:1255513230
Name:MARTIN, CARLA ARNETTE (DPM)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:ARNETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9065 SANDIDGE CENTER CV.
Mailing Address - Street 2:SUITE C
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654
Mailing Address - Country:US
Mailing Address - Phone:662-893-0533
Mailing Address - Fax:662-890-5676
Practice Address - Street 1:9065 SANDIDGE CENTER CV.
Practice Address - Street 2:SUITE C
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654
Practice Address - Country:US
Practice Address - Phone:662-893-0533
Practice Address - Fax:662-890-5676
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80159213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSU78770Medicare UPIN
MS480000120Medicare PIN
MS5154110001Medicare NSC