Lydia  L  Dever    DC
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004926
NPI
1609090034
Tax ID
202817543
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3903 Jiles Road Building 100, Suite 101
Kennesaw, GA 30144
United States
County
Cobb
Phone
6782903263 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Chiropractic Medicine
Map
Address