Theresa    Elango    CRNP
Contract Details
Shepherd Center
Facility name
Provider ID
P000008889
NPI
1255684007
Tax ID
510141601
Effective Date
4/1/2017
Last Updated
7/23/2018
Direct Contract
Yes
Status
Active
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
P.O. Box 116276
Atlanta, GA 30368
Billing Phone
4043671223
Specialty Type
Nurse Practitioner
Map
Address