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General NPI Number Information
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NPI Number | 1447331996
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Entity Type | Organization
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Legal Business Name | BANNERMAN FAMILY CARE LLC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 6721 THOMASVILLE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32312-3837
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Country | US
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Telephone | 850-893-8965
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 100124
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City | ATLANTA
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State | GA
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Zip | 30384-0124
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Country | US
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Telephone | 850-893-8965
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. RAMEL FAILMA
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Credential | M.D.
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Telephone | 850-893-8965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME95073
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License Number State | FL
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