Provider Demographics
NPI:1386662237
Name:MARTIN, STEPHANIE S (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:S
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SUE
Other - Last Name:BANKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3280 HOWELL MILL ROAD NW
Mailing Address - Street 2:STE 205
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1181
Mailing Address - Country:US
Mailing Address - Phone:404-973-2444
Mailing Address - Fax:404-935-9832
Practice Address - Street 1:3280 HOWELL MILL ROAD NW
Practice Address - Street 2:STE 205
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3032
Practice Address - Country:US
Practice Address - Phone:404-973-2444
Practice Address - Fax:404-935-9832
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048913207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000867787CMedicaid
20BBFCZMedicare ID - Type Unspecified
GA000867787CMedicaid