MEDICARE: FAMILY MEDICINE ASSOCIATES OF ABBEVILLE, P.A.

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	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42-3971	OTHER	SC	RURAL HEALTH CLINIC

General Provider Information

NPI Number	:	1740350966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE ASSOCIATES OF ABBEVILLE, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 968
Second Line	:
City	:	ABBEVILLE
State	:	SC
Zip	:	29620-0968
Country	:	US
Telephone Number	:	864-366-9681
Fax Number	:	864-366-5600

Provider Business Practice Location Address
First Line	:	901 W GREENWOOD ST
Second Line	:	SUITE 9
City	:	ABBEVILLE
State	:	SC
Zip	:	29620-5678
Country	:	US
Telephone Number	:	864-366-9681
Fax Number	:	864-366-5600

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARY JO HOLLY
Credential	:
Telephone Number	:	864-388-9681

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	05/30/2013

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