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Daniel
Avery
MD
Contract Details
OrthoSports Associates
Facility name
Provider ID
P000008922
NPI
1235440918
Tax ID
275501752
Effective Date
12/13/2022
Last Updated
1/12/2023
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
M
Exhibit ID
AM_508
Exhibit Attachment
Location Details
Address
2217 Decatur Highway
Gardendale, AL 35071
United States
County
Jefferson
Phone
2054181260
(
Phone
)
Billing Details
Address
2217 Decatur Highway
Birmingham, AL 35071
Billing Phone
2059390447
Specialty Type
Surgery, Orthopedic Hand
Map
Address