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Darin
D
Tessier
MD
Contract Details
Brookwood Sports and Orthopedics
Facility name
Provider ID
P000008201
NPI
1164603866
Tax ID
474758260
Effective Date
10/3/2015
Last Updated
5/16/2016
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
200 Montgomery Highway Suite 200
Birmingham, AL 35216
United States
County
Jefferson
Phone
2059772663
(
Phone
)
Billing Details
Address
P.O. Box 742727
Atlanta, GA 30374
Billing Phone
2059772663
Specialty Type
Sports Medicine
Map
Address