Provider Demographics
NPI:1316041478
Name:FAMILY MEDICAL CENTER-THOMASVILLE PC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER-THOMASVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-636-9613
Mailing Address - Street 1:1415 MOSLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784
Mailing Address - Country:US
Mailing Address - Phone:334-636-9613
Mailing Address - Fax:334-636-9676
Practice Address - Street 1:1415 MOSLEY DRIVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784
Practice Address - Country:US
Practice Address - Phone:334-636-9613
Practice Address - Fax:334-636-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty