George Robert    Booker    MD
Contract Details
Southlake Orthopaedics
Facility name
Provider ID
P000000001
NPI
1760692834
Tax ID
922164113
Effective Date
1/1/2024
Last Updated
1/8/2024
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
4517 Southlake Parkway
Birmingham, AL 35244
United States
County
Jefferson
Phone
2055909756 (Phone)
Billing Details
Address
4517 Southlake Parkway
Birmingham, AL 35244
Billing Phone
2059854111
Specialty Type
Surgery, Orthopedic
Map
Address