Provider Demographics
NPI:1104895374
Name:SHELDON, MARTIN R (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:SHELDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3530
Mailing Address - Country:US
Mailing Address - Phone:478-237-2638
Mailing Address - Fax:478-237-9138
Practice Address - Street 1:215 N COLEMAN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3530
Practice Address - Country:US
Practice Address - Phone:478-237-2638
Practice Address - Fax:478-237-9138
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22570207R00000X
MA264368207R00000X, 207RH0002X
GA062771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC225704Medicaid
GA869000211FMedicaid
MA110104289AMedicaid
MA110104289AMedicaid
3410Medicare PIN
SC225704Medicaid