Provider Demographics
NPI:1750757969
Name:SPARKS, JESSICA DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DIANE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11407 DEPT#8241
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8241
Mailing Address - Country:US
Mailing Address - Phone:256-571-8500
Mailing Address - Fax:256-571-8502
Practice Address - Street 1:7938 AL HIGHWAY 69 STE 350
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7135
Practice Address - Country:US
Practice Address - Phone:256-571-8500
Practice Address - Fax:256-571-8502
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL35699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL258300Medicaid