Great State 2019 Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

GREAT STATE 2019 INC

Practice address

4960 Rice Mine Rd NE Ste 30a
Tuscaloosa, AL 35406-3136

Phone

(205) 509-9055

NPI assigned

Jun 9, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daniel Sparkman

Title

Executive Director

Phone

(205) 509-9055

Specialties & licenses 1

Addresses

Other names 2

• Great State Alabama Doing business as
• Great State Rural Clinics Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1124757588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4960 RICE MINE RD NE STE 30A",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354063136",
            "telephone_number": "205-509-9055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4960 RICE MINE RD NE STE 30A",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354063136",
            "telephone_number": "205-509-9055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT STATE 2019 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "SPARKMAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "205-509-9055"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://26162.portal.athenahealth.com/",
            "affiliation": "N",
            "endpointDescription": "Patient Portal",
            "address_1": "4960 Rice Mine Rd NE Ste 30A",
            "city": "Tuscaloosa",
            "state": "AL",
            "country_code": "US",
            "postal_code": "354063136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Great State Alabama",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great State Rural Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melanie Dyess Graham, M.D.
• Andrew Edward Graves, D.M.D.
• Michael Calvin Graves, M.S. AUDIOLOGY
• Lakesa Gray, LMT
• Morgan Gray
• Greater Al Health Network
• Greater Alabama Health Network
• Greater Alabama Health Network
• Greater Alabama Health Network
• Nicholas Robert Greblick

• Dermatology Physician in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Dermatology Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.