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Emma
M
Stein
PHD
Contract Details
Shepherd Center
Facility name
Provider ID
P000008553
NPI
1871038836
Tax ID
510141601
Effective Date
1/12/2017
Last Updated
7/23/2018
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
M
Exhibit ID
AM_389
AM_389
Location Details
Address
2020 Peachtree Road, NW
Atlanta, GA 30309
United States
County
Fulton
Phone
4043522020
(
Phone
)
Billing Details
Address
P.O. Box 116276
Atlanta, GA 30368
Billing Phone
4043671223
Specialty Type
Neuropsychology
Map
Address