Provider Demographics
NPI:1043215114
Name:MARTIN, SANDRA B (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MONTGOMERY HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1862
Mailing Address - Country:US
Mailing Address - Phone:205-823-0882
Mailing Address - Fax:205-823-0872
Practice Address - Street 1:315 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2913
Practice Address - Country:US
Practice Address - Phone:256-249-5000
Practice Address - Fax:256-249-5079
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19374174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H06542Medicare UPIN