Karen  J  Mockler    MD
Contract Details
Medical Park Family Care
Facility name
Provider ID
P000007372
NPI
1407879083
Tax ID
630385130
Effective Date
3/1/1999
Last Updated
6/10/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1034 South Tallassee Street
Dadeville, AL 36853
United States
County
Tallapoosa
Phone
2568259900 (Phone)
Billing Details
Address
P.O. Box 589
Dadeville, AL 36853
Billing Phone
2568259900
Specialty Type
Family Practice
Map
Address