Patrick  J  Fernicola    MD
Contract Details
Hughston Clinic--Cordele
Facility name
Provider ID
P000000536
NPI
1134161995
Tax ID
581155460
Effective Date
4/15/2010
Last Updated
9/22/2014
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_140
Location Details
Address
910 5th Street North Suite F
Cordele, GA 31015
United States
County
Crisp
Phone
2292760107 (Phone)
Billing Details
Address
P.O. Box 848249
Boston, MA 02284
Billing Phone
7063246661
Specialty Type
Surgery, Orthopedic
Map
Address