Provider Demographics
NPI:1932443868
Name:ANGELA M. MARTIN
Entity Type:Organization
Organization Name:ANGELA M. MARTIN
Other - Org Name:PEDIATRIC CARE CENTER OF NORTHEAST ALABAMA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-368-9800
Mailing Address - Street 1:304 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6012
Mailing Address - Country:US
Mailing Address - Phone:256-237-1184
Mailing Address - Fax:256-237-8400
Practice Address - Street 1:200 BATTLE ST E
Practice Address - Street 2:SUITE B
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2420
Practice Address - Country:US
Practice Address - Phone:256-368-9800
Practice Address - Fax:256-237-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL13331261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health