Provider Demographics
NPI:1902687718
Name:DOCKERY, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:DOCKERY
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 1:96 REEDER BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4000
Mailing Address - Country:US
Mailing Address - Phone:919-879-0946
Mailing Address - Fax:
Practice Address - Street 1:712 WILKINS ST STE C
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4664
Practice Address - Country:US
Practice Address - Phone:919-879-0946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No251S00000XAgenciesCommunity/Behavioral Health