Provider Demographics
NPI:1730270562
Name:MICHAEL G. MARTIN, M.D., LLC
Entity type:Organization
Organization Name:MICHAEL G. MARTIN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLYNN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELSO
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CCSP
Authorized Official - Phone:256-249-2249
Mailing Address - Street 1:209 W SPRING ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2973
Mailing Address - Country:US
Mailing Address - Phone:256-249-2249
Mailing Address - Fax:256-249-8440
Practice Address - Street 1:209 W SPRING ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2973
Practice Address - Country:US
Practice Address - Phone:256-249-2249
Practice Address - Fax:256-249-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty