Individual
TERENCE MALLOY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1600 FORSYTH ST, MACON, GA 31201-1408
(478) 743-3000
Mailing address
1600 FORSYTH ST, MACON, GA 31201-1408
(478) 743-3000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000239
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002814A
—
GA
Enumeration date
01/19/2007
Last updated
09/15/2015
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