Provider Demographics
NPI:1316256233
Name:MARTIN, LAURA LANE
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 WALL ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474-1444
Mailing Address - Country:US
Mailing Address - Phone:931-334-6939
Mailing Address - Fax:
Practice Address - Street 1:902 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3204
Practice Address - Country:US
Practice Address - Phone:931-490-6510
Practice Address - Fax:931-381-0945
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator