Contract Details
Ancillary Care Services
Facility name
Atlanta Dermatopathology & Pathology Associates
Provider ID
P000005126
NPI
1699753913
Tax ID
581753560
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1800 Phoenix Boulevard Suite 210
Atlanta, GA 30349
United States
County
Fulton
Phone
7709941360 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address