Contract Details
Ancillary Care Services
Facility name
Mr. Neb
Provider ID
P000005061
NPI
1669768081
Tax ID
271933918
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
5076 Winters Chapel Road Suite 200
Atlanta, GA 30360
United States
County
DeKalb
Phone
7706140994 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address