Healthcare Provider Details

I. General information

NPI: 1932985611
Provider Name (Legal Business Name): LAURAJANE ELIZABETH MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 TIFT AVE N
TIFTON GA
31794-4468
US

IV. Provider business mailing address

4027 SAPPS LAKE RD
ENIGMA GA
31749-3558
US

V. Phone/Fax

Practice location:
  • Phone: 229-520-3031
  • Fax: 478-205-5294
Mailing address:
  • Phone: 229-339-4491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN269162
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: