# FMC MEDICAL CLINIC - FAYETTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588141063
- **Authorized official:** MR. DANIEL CLAY CONVILLE (CORP DIRECTOR PHYSICIAN SERVICES)
- **Authorized official phone:** (205) 759-6165

## Contact information

- **Practice address:** 1653 TEMPLE AVE N STE 1, FAYETTE, AL 35555-1314
- **Practice address phone:** (205) 932-1112
- **Mailing address:** 1653 TEMPLE AVE N STE 1, FAYETTE, AL 35555-1314
- **Mailing address phone:** (205) 932-1421
- **Mailing address fax:** (205) 932-1428

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/26/2018
- **Last updated:** 10/16/2024