Wennifer    Giglio    NP
Contract Details
Shepherd Center
Facility name
Provider ID
P000000001
NPI
1376884866
Tax ID
510141601
Effective Date
10/21/2020
Last Updated
10/22/2020
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
Phone
404-352-2020 (Phone)
Billing Details
Address
P.O. Box 117330
Atlanta, GA 30368
Billing Phone
404-350-7694
Specialty Type
Nurse Practitioner
Map
Address