Provider Demographics
NPI:1447331996
Name:BANNERMAN FAMILY CARE LLC
Entity type:Organization
Organization Name:BANNERMAN FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAILMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-893-8965
Mailing Address - Street 1:PO BOX 100124
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0124
Mailing Address - Country:US
Mailing Address - Phone:850-893-8965
Mailing Address - Fax:
Practice Address - Street 1:6721 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3837
Practice Address - Country:US
Practice Address - Phone:850-893-8965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0523Medicare PIN