Provider Demographics
NPI:1649538794
Name:FAMILY & COMMUNITY MEDICINE ASSOCIATES, LLC
Entity type:Organization
Organization Name:FAMILY & COMMUNITY MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
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 1:515 STATE DOCKS RD
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-3354
Mailing Address - Country:US
Mailing Address - Phone:334-687-0250
Mailing Address - Fax:334-687-0299
Practice Address - Street 1:515 STATE DOCKS RD
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-3354
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:2012-04-26
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty