Contract Details
Ancillary Care Services
Facility name
Medics of Northeast Georgia
Provider ID
P000003746
NPI
1063795573
Tax ID
453326739
Effective Date
9/27/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
78.00
Location Details
Address
13375 Jones Street Suite D
Lavonia, GA 30553
United States
County
Franklin
Phone
7063561096 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address