Provider Demographics
NPI:1780781211
Name:MARTIN, ANGELA M (MD)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 BATTLE ST E
Mailing Address - Street 2:SUITE B
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2420
Mailing Address - Country:US
Mailing Address - Phone:256-368-9800
Mailing Address - Fax:256-237-8400
Practice Address - Street 1:304 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6012
Practice Address - Country:US
Practice Address - Phone:256-237-1184
Practice Address - Fax:256-237-8400
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2013-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL00013331208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000083412Medicaid
AL000083412Medicaid