Provider Demographics
NPI:1073123709
Name:MED STOP FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:MED STOP FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:LORRI
Authorized Official - Last Name:MARAT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, NP-C
Authorized Official - Phone:478-412-2105
Mailing Address - Street 1:106 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-9204
Mailing Address - Country:US
Mailing Address - Phone:478-412-2105
Mailing Address - Fax:706-432-1620
Practice Address - Street 1:106 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-9204
Practice Address - Country:US
Practice Address - Phone:478-412-2105
Practice Address - Fax:706-432-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003244347AMedicaid