Provider Demographics
NPI:1336201250
Name:CHRISTIAN, MARTHA JO (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JO
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 TEMPLE AVE N
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555
Mailing Address - Country:US
Mailing Address - Phone:205-932-2497
Mailing Address - Fax:205-932-2539
Practice Address - Street 1:1716 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555
Practice Address - Country:US
Practice Address - Phone:205-932-2497
Practice Address - Fax:205-932-2539
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL21289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51099937OtherBC
AL00051274Medicaid
AL51099937OtherBC
AL00051274Medicaid