Provider Demographics
NPI:1528274669
Name:JOHN W MARTIN JR MD PA
Entity type:Organization
Organization Name:JOHN W MARTIN JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-225-5436
Mailing Address - Street 1:1208 ELLA ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4839
Mailing Address - Country:US
Mailing Address - Phone:864-225-5436
Mailing Address - Fax:864-226-3968
Practice Address - Street 1:1208 ELLA ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4839
Practice Address - Country:US
Practice Address - Phone:864-225-5436
Practice Address - Fax:864-226-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC719101YP2500X
SC4618101YP2500X
SC5222208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2218Medicare ID - Type UnspecifiedPROVIDER NUMBER
SCD90718Medicare UPIN