Active NPI
Terence Malloy Martin, PA-C
- Physician Assistant
- Macon, GA
National Provider Identifier
1578616868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000239
- Practice address
- 1600 Forsyth St
Macon, GA 31201-1408 - Phone
- (478) 743-3000
- NPI assigned
- Jan 19, 2007
- Last updated
- Sep 15, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000239 | GA | Primary |
Addresses
Primary practice location
1600 Forsyth St
Macon, GA 31201-1408
Mailing address
1600 Forsyth St
Macon, GA 31201-1408
Phone (478) 743-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100002814A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 239 | GA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| In Stitches PC | Past | Accepting new patients | |
| Macon Surgical Associates | Past | Accepting new patients | |
| Forsyth Street Orthopaedic Surgery and Rehabilitation Center | Past | Accepting new patients | |
| Georgia Interventional Pain Associates, LLC | Past | Accepting new patients | |
| Cardio Thoracic Vascular & Pediatric Surgery Assoc PC | Past | Accepting new patients |
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Macon, GA
- NPI 1366516338
-
- Orthopaedic Surgery Physician
- Macon, GA
- NPI 1215947858
-
dba GA Interventional Pain
- Pain Medicine (Anesthesiology) Physician
- Macon, GA
- NPI 1245935261
-
- Specialist
- Macon, GA
- NPI 1083767461
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442275200000",
"number": "1578616868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 FORSYTH ST",
"city": "MACON",
"state": "GA",
"postal_code": "312011408",
"telephone_number": "478-743-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 FORSYTH ST",
"city": "MACON",
"state": "GA",
"postal_code": "312011408",
"telephone_number": "478-743-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "TERENCE",
"middle_name": "MALLOY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2015-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "000239",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100002814A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.