Jon  E  Sanford    MD
Contract Details
Fayette Medical Center
Facility name
Provider ID
P000002683
NPI
1982676490
Tax ID
636004942
Effective Date
11/5/1996
Last Updated
6/9/2016
Direct Contract
Yes
Term Date
6/12/2014
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_013
Location Details
Address
1653 Temple Avenue North
Fayette, AL 35555
United States
County
Fayette
Phone
2059325966 (Phone)
Billing Details
Address
809 University Boulevard East
Tuscaloosa, AL 35401
Billing Phone
2059325966
Specialty Type
Family Practice
Map
Address