Provider Demographics
NPI:1093048415
Name:ACTS FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:ACTS FAMILY PRACTICE LLC
Other - Org Name:AT YOUR DOOR FAMILY HEALTH CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
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:912-265-7632
Mailing Address - Street 1:815 CHAPEL CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-8861
Mailing Address - Country:US
Mailing Address - Phone:912-265-7632
Mailing Address - Fax:912-265-7632
Practice Address - Street 1:815 CHAPEL CROSSING RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-8861
Practice Address - Country:US
Practice Address - Phone:912-265-7632
Practice Address - Fax:912-265-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129055NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134392913OtherNPI