Provider Demographics
NPI:1467549634
Name:FAMILY & COMMUNITY MEDICINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:FAMILY & COMMUNITY MEDICINE ASSOCIATES LLC
Other - Org Name:JESS C HAGGERTY III SOLE MBR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:CORNELIUS
Authorized Official - Last Name:HAGGERTY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:334-687-0250
Mailing Address - Street 1:405 EAST BARBOUR STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1701
Mailing Address - Country:US
Mailing Address - Phone:334-687-0250
Mailing Address - Fax:334-687-0299
Practice Address - Street 1:405 EAST BARBOUR STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1701
Practice Address - Country:US
Practice Address - Phone:334-687-0250
Practice Address - Fax:334-687-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51536749OtherBCBS PROVIDER #
AL009952520Medicaid
AL131642Medicaid
AL51501961OtherBCBS PROVIDER #
AL63-1271382OtherTRICARE PROVIDER #
AL51117736OtherBCBS PROVIDER #
AL131642Medicaid
AL51536749OtherBCBS PROVIDER #
AL051501961Medicare ID - Type UnspecifiedPROVIDER #