Provider Demographics
NPI:1730412990
Name:MARTIN, ANDY M (CRNA)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:595 W CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:VARNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29944-4735
Mailing Address - Country:US
Mailing Address - Phone:912-338-6511
Mailing Address - Fax:912-338-6512
Practice Address - Street 1:410 DARLING AVE
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5246
Practice Address - Country:US
Practice Address - Phone:912-338-6511
Practice Address - Fax:912-338-6512
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20767367500000X
GARN205128367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered