Healthcare Provider Details

I. General information

NPI: 1992298616
Provider Name (Legal Business Name): STEPHEN R. MARTIN DO, MPA, MSHSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 FAIR RD. DEPARTMENT OF WOUND CARE AND HYPERBARIC MEDICINE
STATESBORO GA
30458
US

IV. Provider business mailing address

1499 FAIR RD. DEPARTMENT OF WOUND CARE AND HYPERBARIC MEDICINE
STATESBORO GA
30458
US

V. Phone/Fax

Practice location:
  • Phone: 912-486-1163
  • Fax: 970-660-0912
Mailing address:
  • Phone: 912-486-1163
  • Fax: 912-486-1163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.015513
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: