Individual
DR. LISA WOOTEN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
603 WHEAT AVE, SUITE 650, BAINBRIDGE, GA 39819-4360
(229) 243-8597
(229) 243-1506
Mailing address
603 WHEAT AVE, SUITE 650, BAINBRIDGE, GA 39819-4360
(229) 243-8597
(229) 243-1506
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT002548
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003104546A
—
GA
01
—
OPT002548
MEDICAL LICENSE
GA
Enumeration date
08/12/2009
Last updated
09/13/2017
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