Provider Demographics
NPI:1336503960
Name:FAMILY MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-335-3077
Mailing Address - Street 1:108 GAY ST
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1228
Mailing Address - Country:US
Mailing Address - Phone:423-388-4525
Mailing Address - Fax:423-388-4524
Practice Address - Street 1:108 GAY ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1228
Practice Address - Country:US
Practice Address - Phone:423-388-4525
Practice Address - Fax:423-388-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-09
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20178261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care