1093048415 NPI number — ACTS FAMILY PRACTICE LLC

Table of content: (NPI 1093048415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093048415 NPI number — ACTS FAMILY PRACTICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTS FAMILY PRACTICE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093048415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 CHAPEL CROSSING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31525-8861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-265-7632
Provider Business Mailing Address Fax Number:
912-265-7632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 CHAPEL CROSSING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31525-8861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-265-7632
Provider Business Practice Location Address Fax Number:
912-265-7632
Provider Enumeration Date:
09/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARAT
Authorized Official First Name:
PATTI
Authorized Official Middle Name:
LORRI
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
912-265-7632

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN129055NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1134392913 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com