| Organization Name: | MARTIN CHILDREN'S CLINIC, LLC |
| NPI Number: | 1194049064 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHARON PIERCE PAGE (OWNER) |
| Mailing Address: | 215 Hawks Rd Suite 3 Martin |
| State: | TN US |
| Postal Code: | 382372708 |
| Phone Number: | 7316811577 |
| Fax Number: | 7316811532 |
| NPI Enumeration Date: | 03/22/2010 |
| NPI Last Update Date: | 01/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 12549 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |