MEDICARE: DR. STEPHEN MARTIN LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1477440592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. STEPHEN MARTIN LLC.

Provider Business Mailing Address
First Line	:	PO BOX 164
Second Line	:
City	:	BROOKLET
State	:	GA
Zip	:	30415-0164
Country	:	US
Telephone Number	:
Fax Number	:	912-486-1165

Provider Business Practice Location Address
First Line	:	1497 FAIR RD STE 103
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-0823
Country	:	US
Telephone Number	:	912-486-1163
Fax Number	:	912-486-1165

Authorized Official
Title or Position	:	CEO
Name	:	DR. STEPHEN MARTIN
Credential	:	DO
Telephone Number	:	912-486-1163

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	12/21/2025

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