Amanda    Maddox    NP
Contract Details
Facility name
Provider ID
P000000001
NPI
1073109708
Tax ID
363966745
Effective Date
5/3/2021
Last Updated
5/3/2021
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
107.00
Fee Schedule Multiplier
Location Details
Address
6345 Airport Blvd Suite J
Mobile, AL 36608
United States
Phone
877-448-3627 (Phone)
Billing Details
Address
6345 Airport Blvd
Suite J
Mobile, AL 36608
Billing Phone
877-448-3627
Specialty Type
Infectious Diseases
Map
Address