Individual
ERICA NICOLE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
364 N PARKWAY STE 8, JACKSON, TN 38305-2874
(731) 431-7241
(731) 736-1111
Mailing address
364 N PARKWAY STE 8, JACKSON, TN 38305-2874
(731) 736-1005
(731) 736-1111
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
I000000022582
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q087092
—
TN
Enumeration date
10/16/2023
Last updated
05/06/2024
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