Jerrold    Clark    MD
Contract Details
AmeriPath
Facility name
Provider ID
P000006708
NPI
1700866324
Tax ID
581267100
Effective Date
5/16/2012
Last Updated
9/25/2013
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
DermPath Diagnostic 2275 Northwest Parkway, Suite 140
Marietta, GA 300679321
United States
County
Cobb
Phone
7709511793 (Phone)
Billing Details
Address
PO Box 100191
Atlanta, GA 303840191
Billing Phone
2146895013
Specialty Type
Pathology, Clinical
Map
Address