Provider Demographics
NPI:1770224495
Name:ENSIGN FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:ENSIGN FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:STORMANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-490-5080
Mailing Address - Street 1:1302 PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3537
Mailing Address - Country:US
Mailing Address - Phone:912-490-5080
Mailing Address - Fax:
Practice Address - Street 1:1302 PLANT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3537
Practice Address - Country:US
Practice Address - Phone:912-490-5080
Practice Address - Fax:912-490-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty