Provider Demographics
NPI:1255441705
Name:SPARACINO, KATHY JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:JEAN
Last Name:SPARACINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 14TH AVENUE SE
Mailing Address - Street 2:SUITE G100
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601
Mailing Address - Country:US
Mailing Address - Phone:256-340-5150
Mailing Address - Fax:256-340-5153
Practice Address - Street 1:1107 14TH AVE SE
Practice Address - Street 2:SUITE G100
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3309
Practice Address - Country:US
Practice Address - Phone:256-340-5150
Practice Address - Fax:256-340-5153
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-11-12
Deactivation Date:2008-04-25
Deactivation Code:
Reactivation Date:2008-05-07
Provider Licenses
StateLicense IDTaxonomies
TNMD41025207Q00000X
AL16163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891-09587OtherBCBS OF ALABAMA
AL009938191Medicaid
ALF08395Medicare UPIN