Nazia  Q  Bandukwala    DO
Contract Details
Sheherd Center
Facility name
Provider ID
P000008493
NPI
1669601167
Tax ID
510141601
Effective Date
9/15/2016
Last Updated
9/21/2016
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
70.00
Location Details
Address
2020 Peachtree Raod NW
Atlanta, GA 30309
United States
County
Fulton
Phone
4043522020 (Phone)
Billing Details
Address
PO Box 116276
Atlanta, GA 30368
Billing Phone
4043671223
Specialty Type
Addiction Medicine
Map
Address