Provider Demographics
NPI:1265222749
Name:MARTIN, SKYLAR DOROUGH (FNP-BC)
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:DOROUGH
Last Name:MARTIN
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N POINTE DR
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-7370
Mailing Address - Country:US
Mailing Address - Phone:229-425-7863
Mailing Address - Fax:
Practice Address - Street 1:189 IRWINVILLE HWY
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8439
Practice Address - Country:US
Practice Address - Phone:229-425-7863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN287075163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice