Laura    Hoskins    PSYD
Contract Details
Shepherd Center
Facility name
Provider ID
P000008508
NPI
1700113883
Tax ID
510141601
Effective Date
10/13/2015
Last Updated
7/30/2018
Direct Contract
Yes
Term Date
7/1/2018
Status
Contract Discounts
Discount Type
M
Exhibit ID
AM_389
Location Details
Address
2020 Peachtree Road 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
Neuropsychology
Map
Address