Provider Demographics
NPI:1891846044
Name:FAMILY PRACTICE CENTER OF ABBEVILLE,P.A.
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER OF ABBEVILLE,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:MURRY
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-585-6421
Mailing Address - Street 1:217 DOTHAN RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36310-2836
Mailing Address - Country:US
Mailing Address - Phone:334-585-6421
Mailing Address - Fax:334-585-6159
Practice Address - Street 1:217 DOTHAN RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36310-2836
Practice Address - Country:US
Practice Address - Phone:334-585-6421
Practice Address - Fax:334-585-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-90207Q00000X
ALDO-89207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE05982Medicare UPIN
ALE05987Medicare UPIN