Greg    Thompson    MD
Contract Details
Facility name
Provider ID
P000000001
NPI
1083093652
Tax ID
462447900
Effective Date
12/17/2020
Last Updated
1/11/2021
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
1912 AL Highway 157
Cullman, AL 35058
United States
Phone
2567372000 (Phone)
Billing Details
Address
1912 AL Highway 157
Cullman, AL 35058
Billing Phone
2567372000
Specialty Type
General Practice
Website
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