Healthcare Provider Details

I. General information

NPI: 1215095237
Provider Name (Legal Business Name): BARNES FAMILY MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 WEST FRONT ST
EVERGREEN AL
36401-3005
US

IV. Provider business mailing address

680 WEST FRONT ST
EVERGREEN AL
36401-3005
US

V. Phone/Fax

Practice location:
  • Phone: 251-578-5111
  • Fax: 251-578-5991
Mailing address:
  • Phone: 251-578-5111
  • Fax: 251-578-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14585
License Number StateAL

VIII. Authorized Official

Name: STANLEY BARNES
Title or Position: PRESIDENT
Credential: MD
Phone: 251-578-5111