Kevin    Glenn    PA-C
Contract Details
Shepherd Center
Facility name
Provider ID
P000000001
NPI
1952749947
Tax ID
510141601
Effective Date
3/17/2022
Last Updated
3/18/2022
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
2020 Peachtree Road Northwest
Atlanta, GA 30309
Billing Phone
404-352-2020
Specialty Type
Physician Assistant
Map
Address