| Fmg Primecare Llc | |
|
4126 W Main St Dothan AL 36305-9310 | |
| (334) 793-2120 | |
| Not Available |
| Full Name | Fmg Primecare Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4126 W Main St, Dothan, Alabama |
| Authorized Official Name and Position | Jenny L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 8778929815 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fmg Primecare Llc Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7230 | Fmg Primecare Llc 4126 W Main St Dothan AL 36305-9310 Ph: (334) 793-2120 |
| NPI Number | 1427578228 |
|---|---|
| Provider Enumeration Date | 06/22/2017 |
| Last Update Date | 06/27/2022 |
| Medicare PECOS PAC ID | 7012283864 |
|---|---|
| Medicare Enrollment ID | O20171023000535 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427578228 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Michael A Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679542740 PECOS PAC ID: 6800798646 Enrollment ID: I20040122001024 |
| Provider Name | Mathew G Krista |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093779738 PECOS PAC ID: 2961403001 Enrollment ID: I20070116000565 |
| Provider Name | Yusef Williams |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699904243 PECOS PAC ID: 5597911487 Enrollment ID: I20120808000770 |
| Provider Name | Krystal Sims Fowler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720426133 PECOS PAC ID: 3072754787 Enrollment ID: I20130723000450 |
| Provider Name | Valerie Thomley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831570670 PECOS PAC ID: 6406164490 Enrollment ID: I20150924000664 |
| Provider Name | Meghan Cole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174049779 PECOS PAC ID: 3476828567 Enrollment ID: I20170928002681 |
| Provider Name | Amanda C Guettler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366831935 PECOS PAC ID: 4688068406 Enrollment ID: I20220629001526 |
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