Stephanie    Polk    CRNP
Contract Details
Shepherd Center
Facility name
Provider ID
P000008903
NPI
1306387972
Tax ID
510141601
Effective Date
7/1/2017
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 Northwest
Atlanta, GA 30309
United States
County
Fulton
Phone
4043522020 (Phone)
Billing Details
Address
2020 Peachtree Road Northwest
Atlanta, GA 30309
Billing Phone
4043522020
Specialty Type
Nurse Practitioner
Map
Address