Tiffany    Sparks    NP
Contract Details
Sand Mountain Family Practice Center
Facility name
Provider ID
P000000001
NPI
1770077885
Tax ID
630740093
Effective Date
2/23/2022
Last Updated
3/11/2022
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
5104 US Highway 431
Albertville, AL 35950
United States
Phone
256-878-8180 (Phone)
Billing Details
Address
5104 US Highway 431
Albertville, AL 35950
Billing Phone
256-878-8180
Specialty Type
Nurse Practitioner
Map
Address