Contract Details
Ancillary Care Services
Facility name
Marietta Imaging at North Cobb
Provider ID
P000005952
Tax ID
582620460
Effective Date
4/1/2012
Last Updated
9/30/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
4791 South Main Street Suite 140
Acworth, GA 30101
United States
County
Cobb
Phone
6787016868 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Diagnostic Services
Map
Address