David  C  Campbell    MD
Contract Details
Lakeside Clinic North
Facility name
Provider ID
P000007267
NPI
1811100985
Tax ID
273149926
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
7938 Highway 69 Suite 130
Guntersville, AL 35976
United States
County
Marshall
Phone
2565718460 (Phone)
Billing Details
Address
7938 Highway 69
Suite 130
Guntersville, AL 35976
Billing Phone
2565718460
Specialty Type
Family Practice
Map
Address