Aiwane    Iboaya    DO
Contract Details
Shepherd Center
Facility name
Provider ID
P000009400
NPI
1386064814
Tax ID
510141601
Effective Date
8/1/2019
Last Updated
9/10/2019
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
Physical Medicine & Rehabilitation
Map
Address