Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 007006 | GA |
NPI | 1003085069 |
---|---|
Provider Name | Dr. Robert Lane Martin |
First Address | Martinez, GA 30907-4253 |
Second Address | Martinez, GA 30907-4253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2008 |
Last Update Date | 25/02/2008 |