Martha Jo Christian MD PC
Organization Active NPI Internal Medicine Physician · Fayette, AL
NPI 1083612295 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1083612295
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 21289 (AL)
- Legal business name
- MARTHA JO CHRISTIAN MD PC
- Practice address
- 1716 Temple Ave N
Fayette, AL 35555-1309 - Phone
- (205) 932-2497
- Fax
- (205) 932-2539
- NPI assigned
- Jul 12, 2005
- Organization subpart
- No
Authorized official
- Name
- Martha J Christian, MD
- Title
- President
- Phone
- (205) 932-2497
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D2061972 | Martha Jo Christian MD PC | Certificate of waiver | Dec 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070321000128 | AL | Part B Supplier - Clinic/Group Practice | 8527161041 |
Receives reassigned benefits from 1 practitioner Practice locations: Fayette, AL |
National Provider Directory
Locations
1716 Temple Ave N
Ste 4
Fayette, AL 35555
Phone (205) 932-2497
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 21289 | AL | Yes |
Addresses
Primary practice location
1716 Temple Ave N
Fayette, AL 35555-1309
Mailing address
1716 Temple Ave N
Fayette, AL 35555-1309
Phone (205) 932-2497
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 99937 | Other | AL | BC |
Other providers in Fayette, AL
- Ronald Garrett Lawrence
- William L Lenahan
- Hillary Paige Lowery
- Dwanla Smith Madden
- Garry W Magouirk
- May Eye Care, P.C.
- Randy Chad May
- Medcenter Fayette, LLC
- William Trent Mobley
- Patricia Lorraine Montgomery
All providers in Fayette, AL · Internal Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.