Chiazom  C  Omeruah    DO
Contract Details
American Family Care--Prattville
Facility name
Provider ID
P000007900
NPI
1265698922
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
1965 Cobbs Ford Road
Prattville, AL 36066
United States
County
Autauga
Phone
3343617054 (Phone)
Billing Details
Address
P.O. Box 830810
Birmingham, AL 35283
Billing Phone
2054038902
Specialty Type
Family Practice
Map
Address