John  R  Sass    PHD
Contract Details
Restore Neurobehavioral Center
Facility name
Provider ID
P000002684
NPI
1093858854
Tax ID
582287958
Effective Date
12/15/2010
Last Updated
2/22/2021
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
M
Exhibit ID
AM_474
Location Details
Address
5578 Lions Club Drive Northwest
Lilburn, GA 30047
United States
County
Gwinnett
Phone
7709356999 (Phone)
Billing Details
Address
5578 Lions Club Drive Northwest
Atlanta, GA 30047
Billing Phone
7705638248
Specialty Type
Neuropsychology
Map
Address