Madison    McCullough    MD
Contract Details
DeKalb Specialty Care
Facility name
Provider ID
P000000001
NPI
1972366854
Tax ID
990863555
Effective Date
12/19/2024
Last Updated
1/16/2025
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
90.00
Location Details
Address
406 Taylor Street
Scottsboro, AL 35768
United States
Phone
833-255-8862 (Phone)
Billing Details
Address
406 Taylor Street
Scottsboro, AL 35768
Billing Phone
833-255-8862
Specialty Type
ENT - Ears Nose & Throat
Map
Address