Glenn  C  Terry    MD
Contract Details
Hughston Clinic--Albany-Leesburg
Facility name
Provider ID
P000001722
NPI
1558304576
Tax ID
581155460
Effective Date
4/15/2010
Last Updated
9/22/2014
Direct Contract
Yes
Term Date
5/15/2013
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_140
Location Details
Address
117 Oakland Parkway
Leesburg, GA 31763
United States
County
Lee
Phone
2294830055 (Phone)
Billing Details
Address
P.O. Box 848249
Boston, MA 02284
Billing Phone
7063246661
Specialty Type
Surgery, Orthopedic
Map
Address