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James
Torell
PA-C
Contract Details
Shepherd Center
Facility name
Provider ID
P000000001
NPI
1336525641
Tax ID
510141601
Effective Date
7/1/2020
Last Updated
7/14/2020
Direct Contract
Yes
Status
Active
W9 Attachment
Contract Discounts
Discount Type
M
Exhibit ID
AM_389
Exhibit Attachment
Location Details
Address
2020 Peachtree Road Northwest
Atlanta, GA 30309
United States
Phone
404-352-2020
(
Phone
)
Billing Details
Address
2020 Peachtree Road Northwest
Atlanta, GA 30309
Billing Phone
404-352-2020
Specialty Type
Neurology
Map
Address