Healthcare Provider Details

I. General information

NPI: 1093602153
Provider Name (Legal Business Name): OGEECHEE WOUND HEALING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
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

PO BOX 164
BROOKLET GA
30415
US

V. Phone/Fax

Practice location:
  • Phone: 912-296-8633
  • Fax:
Mailing address:
  • Phone: 912-296-8633
  • Fax: 970-660-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN MARTIN
Title or Position: EXECUTIVE DIRECTOR
Credential: DO
Phone: 912-296-8633