Organization
GREAT STATE 2019 INC
Active
Other names
Great State Alabama, Great State Rural Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL SPARKMAN (EXECUTIVE DIRECTOR)
(205) 509-9055
Entity
Organization
Contact information
Practice address
4960 RICE MINE RD NE STE 30A, TUSCALOOSA, AL 35406-3136
(205) 509-9055
Mailing address
4960 RICE MINE RD NE STE 30A, TUSCALOOSA, AL 35406-3136
(205) 509-9055
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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