Frederick    Yerby   
Contract Details
Facility name
Provider ID
P000000001
NPI
1528028982
Tax ID
631096449
Effective Date
4/6/2020
Last Updated
4/7/2020
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1716 Temple Avenue North Suite 6
Fayette, AL 35555
United States
Phone
205-932-7750 (Phone)
Billing Details
Address
1716 Temple Avenue North
Suite 6
Fayette, AL 35555
Billing Phone
205-932-7750
Specialty Type
Family Practice
Map
Address