Ashlee  M  Fulmer    MD
Contract Details
Southside Pain Specialists
Facility name
Provider ID
P000007999
NPI
1134355845
Tax ID
261605441
Effective Date
9/1/2014
Last Updated
6/15/2017
Direct Contract
Yes
Term Date
9/21/2016
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
1020 26th Street South Suite 100
Birmingham, AL 35205
United States
County
Jefferson
Phone
2053323155 (Phone)
Billing Details
Address
1020 26th Street South
Birmingham, AL 35205
Billing Phone
2053323155
Specialty Type
Physical Medicine & Rehabilitation
Map
Address