William  A  Nixon    MD
Contract Details
Lakeside Clinic
Facility name
Provider ID
P000007262
NPI
1699731927
Tax ID
631246103
Effective Date
3/11/2013
Last Updated
6/3/2013
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
105.00
Fee Schedule Multiplier
Location Details
Address
2337 Homer Clayton Drive
Guntersville, AL 35976
United States
County
Marshall
Phone
2565825131 (Phone)
Billing Details
Address
2337 Homer Clayton Drive
Guntersville, AL 35976
Billing Phone
2565825131
Specialty Type
Family Practice
Map
Address