MEDICARE: INTERNAL MEDICINE ASSOCIATES OF MADISON, LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1518611433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE ASSOCIATES OF MADISON, LLC

Provider Business Mailing Address
First Line	:	241 MILL WALK CT
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-1565
Country	:	US
Telephone Number	:	915-227-1977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 BELTLINE RD SW
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-5506
Country	:	US
Telephone Number	:	256-353-3500
Fax Number	:	256-353-6878

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RAPHAEL KOBINA QUANSAH
Credential	:	MD
Telephone Number	:	915-227-1977

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	02/09/2022

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