Darren Paul    Gannuch    MD
Contract Details
DeKalb Regional Medical Center
Facility name
Provider ID
P000000590
NPI
1669401709
Tax ID
204370870
Effective Date
12/1/2008
Last Updated
6/13/2014
Direct Contract
Yes
Term Date
4/25/2013
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_011
Location Details
Address
11491 Highway 431
Albertville, AL 35950
United States
County
Marshall
Phone
2568946605 (Phone)
Billing Details
Address
P.O. Box 277507
Atlanta, GA 30384
Billing Phone
2569972317
Specialty Type
Psychiatry
Map
Address