Kennieth  C  McCollough  Jr  MD
Contract Details
Coosa Valley Sports Medicine and Primary Care
Facility name
Provider ID
P000007281
NPI
1720243421
Tax ID
464236117
Effective Date
5/19/2015
Last Updated
7/15/2015
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
209 West Spring Street Suite 305
Sylacauga, AL 35150
United States
County
Talladega
Phone
2562453201 (Phone)
Billing Details
Address
209 West Spring Street
Suite 305
Sylacauga, AL 35150
Billing Phone
2562453201
Specialty Type
Internal Medicine
Map
Address