Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OT016512 | PA |
N | 111NI0900X | Internist | OT016512 | PA |
NPI | 1003295239 |
---|---|
Provider Name | Jennifer Lee Martin |
First Address | Charleston, SC 29425-3230 |
Second Address | Charleston, SC 29425-3230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 24/11/2020 |