MEDICARE: FAMILY MEDICINE ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1053484097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	PO BOX 5689
Second Line	:	1813 BELTLINE ROAD SW
City	:	DECATUR
State	:	AL
Zip	:	35601-0689
Country	:	US
Telephone Number	:	256-353-6874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 BELTLINE RD SW
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-5506
Country	:	US
Telephone Number	:	256-353-6874
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE
Name	:	WENDY BURNEY
Credential	:
Telephone Number	:	256-353-6874

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	11/19/2009

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