Contract Details
Ancillary Care Services
Facility name
South Pathology
Provider ID
P000005138
NPI
1699893412
Tax ID
208693594
Effective Date
4/1/2012
Last Updated
9/27/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
88.00
Location Details
Address
1520 North Leg Road
Augusta, GA 30909
United States
County
Richmond
Phone
7064344100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Laboratory Service Provider
Map
Address