Healthcare Provider Details

I. General information

NPI: 1891846044
Provider Name (Legal Business Name): FAMILY PRACTICE CENTER OF ABBEVILLE,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 DOTHAN RD
ABBEVILLE AL
36310-2836
US

IV. Provider business mailing address

217 DOTHAN RD
ABBEVILLE AL
36310-2836
US

V. Phone/Fax

Practice location:
  • Phone: 334-585-6421
  • Fax: 334-585-6159
Mailing address:
  • Phone: 334-585-6421
  • Fax: 334-585-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-89
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-90
License Number StateAL

VIII. Authorized Official

Name: MS. BERNICE MURRY MASSEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-585-6421