Ashley    Coleman    DO
Contract Details
Family Medical of Jackson
Facility name
Provider ID
P000008248
NPI
1124216551
Tax ID
721345993
Effective Date
10/30/1992
Last Updated
9/14/2016
Direct Contract
Yes
Term Date
2/29/2016
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
227 Hospital Drive
Jackson, AL 36545
United States
County
Clarke
Phone
2512464446 (Phone)
Billing Details
Address
227 Hospital Drive
Jackson, AL 36545
Billing Phone
2512464446
Specialty Type
Family Practice
Map
Address