Organization
MARTIN PEDIATRIC AND ADOLESCENT CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA ROBERTS (OFFICE MANAGER)
(731) 587-9542
Entity
Organization
Contact information
Practice address
142 MOUNT PELIA RD, MARTIN, TN 38237-3812
(731) 587-9542
Mailing address
142 MOUNT PELIA RD, MARTIN, TN 38237-3812
(731) 587-9542
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
MD 18562
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3727836
—
TN
Enumeration date
02/16/2007
Last updated
07/11/2007
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