Healthcare Provider Details

I. General information

NPI: 1952425019
Provider Name (Legal Business Name): FAMILY MEDICINE ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MEDICAL CENTER CT
PRATTVILLE AL
36066-7288
US

IV. Provider business mailing address

204 MEDICAL CENTER CT
PRATTVILLE AL
36066-7288
US

V. Phone/Fax

Practice location:
  • Phone: 334-361-3090
  • Fax: 334-361-2090
Mailing address:
  • Phone: 334-361-3090
  • Fax: 334-361-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23409
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16083
License Number StateAL

VIII. Authorized Official

Name: DANIEL E BANACH
Title or Position: OWNER
Credential: M.D.
Phone: 334-361-3090