Individual
MR. THOMAS FOSTER MARTIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.P.O
Contact information
Practice address
1113 N FANT ST, ANDERSON, SC 29621-4819
(864) 225-1683
(864) 231-7374
Mailing address
1010 HOBBY LN, ANDERSON, SC 29621-3547
(864) 224-5446
(864) 231-7374
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
1245288745
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00926428A
GEORGIA MEDICAID
GA
05
—
DE1943
—
SC
Enumeration date
03/08/2007
Last updated
07/09/2007
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