O. Henry    Ajibowo    MD
Contract Details
Georgia Pain Physicians of Marietta
Facility name
Provider ID
P000007225
NPI
1235320151
Tax ID
582318726
Effective Date
2/15/2004
Last Updated
12/12/2017
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
2550 Windy Hill Road Southeast Suite 215
Marietta, GA 30067
United States
County
Cobb
Phone
7708508464 (Phone)
Billing Details
Address
2550 Windy Hill Road Southeast
Suite 215
Marietta, GA 30067
Billing Phone
7708508464
Specialty Type
Pain Management
Map
Address