Individual
JOHN EDWARD MARTIN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1497 FAIR RD, SUITE 103, STATESBORO, GA 30458-0822
(912) 486-1163
(866) 795-4593
Mailing address
PO BOX 922088, NORCROSS, GA 30010-2088
(866) 795-4593
(866) 795-4593
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
25229
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000346376B
—
GA
01
—
1073707436
NPI
GA
01
—
P00387675
MEDICARE RAILROAD
GA
Enumeration date
11/07/2006
Last updated
09/24/2018
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