MEDICARE: FMR AND ASSOCIATES

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	231H00000X	Audiologist		TX

General Provider Information

NPI Number	:	1851324354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FMR AND ASSOCIATES

Provider Business Mailing Address
First Line	:	5702 CARRINGTON LAKE PKWY
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-2895
Country	:	US
Telephone Number	:	770-798-1274
Fax Number	:

Provider Business Practice Location Address
First Line	:	5702 CARRINGTON LAKE PKWY
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-2895
Country	:	US
Telephone Number	:	770-798-1274
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FRANK MICHAEL ROBERTS SR.
Credential	:
Telephone Number	:	770-798-1274

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	04/20/2008

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