Emily    Lazenby    MD
Contract Details
Psychiatry South
Facility name
Provider ID
P000000971
NPI
1992914956
Tax ID
631181094
Effective Date
1/1/1996
Last Updated
5/6/2014
Direct Contract
Yes
Term Date
5/6/2014
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
200 Chase Park South Suite 102
Birmingham, AL 35244
United States
County
Jefferson
Phone
2059870724 (Phone)
Billing Details
Address
200 Chase Park South
Suite 102
Birmingham, AL 35244
Billing Phone
2059870724
Specialty Type
Psychiatry
Map
Address