Luz Jovita  T  Crystal    MD
Contract Details
DeKalb Regional Medical Center
Facility name
Provider ID
P000000370
NPI
1972544153
Tax ID
204370870
Effective Date
12/1/2008
Last Updated
6/13/2014
Direct Contract
Yes
Term Date
6/13/2014
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_011
Location Details
Address
2202 Jordan Road Southwest Suite 500
Fort Payne, AL 35968
United States
County
De Kalb
Phone
2568442825 (Phone)
Billing Details
Address
P.O. Box 277507
Atlanta, GA 30384
Billing Phone
2569972317
Specialty Type
Internal Medicine
Map
Address