=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134392913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATTI LORRI MARAT RN MSN APRN NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2008
-----------------------------------------------------
Last Update Date | 03/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 W 2ND AVE
-----------------------------------------------------
City | SANDERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31082-9204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-412-2105
-----------------------------------------------------
Fax | 706-432-1620
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 633
-----------------------------------------------------
City | SANDERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31082-0633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-412-2105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN129055 NP
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------