Great State 2019 INC
NPI #1124757588 in Tuscaloosa, Alabama
Provider Information
- NPI Number
- 1124757588
- Entity Type
- Organization
- Organization Name
- Great State 2019 INC
- Primary Specialty
- Dermatology
- Enumeration Date
- Jun 9, 2022
- Last Updated
- Jun 9, 2022
Practice Location
- Address
- 4960 RICE MINE RD NE STE 30A
- City
- Tuscaloosa
- State
- Alabama
- ZIP Code
- 35406-3136
- Phone
- (205) 509-9055
Authorized Official
- Name
- DANIEL SPARKMAN
- Title
- EXECUTIVE DIRECTOR
- Phone
- (205) 509-9055
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dermatology |
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