Provider Demographics
NPI:1154423499
Name:MARTIN, ANDREW AYERS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:AYERS
Last Name:MARTIN
Suffix:
Gender:M
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:PO BOX 820662
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39182-0662
Mailing Address - Country:US
Mailing Address - Phone:601-636-0097
Mailing Address - Fax:
Practice Address - Street 1:1970 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7202
Practice Address - Country:US
Practice Address - Phone:662-624-3429
Practice Address - Fax:662-621-9158
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14355207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS14355OtherMS MEDICAL LICENSES
MS115777Medicaid
MS512I220024Medicare PIN
MS14355OtherMS MEDICAL LICENSES