Healthcare Provider Details

I. General information

NPI: 1477440592
Provider Name (Legal Business Name): DR. STEPHEN MARTIN LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 FAIR RD STE 103
STATESBORO GA
30458-0823
US

IV. Provider business mailing address

PO BOX 164
BROOKLET GA
30415-0164
US

V. Phone/Fax

Practice location:
  • Phone: 912-486-1163
  • Fax: 912-486-1165
Mailing address:
  • Phone:
  • Fax: 912-486-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN MARTIN
Title or Position: CEO
Credential: DO
Phone: 912-486-1163