Provider Demographics
NPI:1346580982
Name:MYFAMILYDOC LLC
Entity Type:Organization
Organization Name:MYFAMILYDOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAVIN
Authorized Official - Middle Name:BATUK
Authorized Official - Last Name:TALATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-778-3912
Mailing Address - Street 1:101 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-4565
Mailing Address - Country:US
Mailing Address - Phone:706-778-3912
Mailing Address - Fax:706-776-6259
Practice Address - Street 1:101 ADAMS DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4565
Practice Address - Country:US
Practice Address - Phone:706-778-3912
Practice Address - Fax:706-776-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty