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General NPI Number Information
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NPI Number | 1073123709
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Entity Type | Organization
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Legal Business Name | MED STOP FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 106 W 2ND AVE
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City | SANDERSVILLE
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State | GA
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Zip | 31082-9204
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Country | US
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Telephone | 478-412-2105
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Fax | 706-432-1620
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Provider Business Mailing Address
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Address Line | 106 W 2ND AVE
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City | SANDERSVILLE
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State | GA
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Zip | 31082-9204
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Country | US
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Telephone | 478-412-2105
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Fax | 706-432-1620
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | PATTI LORRI MARAT
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Credential | APRN, NP-C
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Telephone | 478-412-2105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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