Individual
MARTHA BIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2 PROFESSIONAL PARK DR STE 21, JOHNSON CITY, TN 37604-6584
(423) 379-8120
(423) 379-8153
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 439-8000
(423) 439-2200
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
45132
TN
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
45132
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514506
—
TN
01
—
3714470
GROUP TN MEDICARE NUMBER
TN
Enumeration date
11/16/2007
Last updated
01/16/2024
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