Provider Demographics
NPI:1982885919
Name:JEFFREY H MARTIN MD PA
Entity Type:Organization
Organization Name:JEFFREY H MARTIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARTIN MD PA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-835-3900
Mailing Address - Street 1:STE-A
Mailing Address - Street 2:75 MEDICAL PARK LN
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-6673
Mailing Address - Country:US
Mailing Address - Phone:828-835-3900
Mailing Address - Fax:828-835-3006
Practice Address - Street 1:47 WEAVER RD
Practice Address - Street 2:SUITE B
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3136
Practice Address - Country:US
Practice Address - Phone:706-745-3862
Practice Address - Fax:706-745-3179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY H MARTIN MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1901307OtherUNITED HEALTH CARE
GA7598763OtherAETNA
GA854396OtherBLUE CROSS BLUE SHIELD
GA854396OtherBLUE CROSS BLUE SHIELD
GA7598763OtherAETNA
GA7598763OtherAETNA
GAP00256390Medicare PIN