Provider Demographics
NPI:1447376660
Name:TM MARTIN INC
Entity type:Organization
Organization Name:TM MARTIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:MALLOY
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PC-C
Authorized Official - Phone:478-743-4321
Mailing Address - Street 1:238 WESLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2458
Mailing Address - Country:US
Mailing Address - Phone:478-972-7755
Mailing Address - Fax:478-743-5544
Practice Address - Street 1:238 WESLEY CIR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2458
Practice Address - Country:US
Practice Address - Phone:478-972-7755
Practice Address - Fax:478-743-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000239363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty