Susan  A  Jordan    MD
Contract Details
American Family Care--Fairhope
Facility name
Provider ID
P000007836
NPI
1952361776
Tax ID
630825248
Effective Date
7/1/2011
Last Updated
4/24/2018
Direct Contract
Yes
Term Date
4/24/2018
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
10040 County Road 48 Suite A
Fairhope, AL 36532
United States
County
Baldwin
Phone
2515178055 (Phone)
Billing Details
Address
P.O. Box 830810
Birmingham, AL 35283
Billing Phone
2054038902
Specialty Type
General Practice
Map
Address