Robert    Bradley    MD
Contract Details
AmeriPath
Facility name
Provider ID
P000006713
NPI
1164401287
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
Coliseum Medical Centers 350 Hospital Drive
Macon, GA 312173838
United States
County
Bibb
Phone
4787430212 (Phone)
Billing Details
Address
PO Box 100191
Atlanta, GA 303840191
Billing Phone
4075874457
Specialty Type
Pathology, Clinical
Map
Address