Samuel  F  Hollingsworth    MD
Contract Details
Alabama Eye Services Network
Facility name
Provider ID
P000000775
NPI
1790890986
Tax ID
630910560
Effective Date
3/1/1999
Last Updated
5/5/2014
Direct Contract
Yes
Term Date
5/5/2014
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
2545 Highway 78 East
Jasper, AL 35501
United States
County
Walker
Phone
2052219790 (Phone)
Billing Details
Address
2545 Highway 78 East
Jasper, AL 35501
Billing Phone
2052219790
Specialty Type
Ophthalmology
Map
Address