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Mark
A
Goddard
MD
Contract Details
ImageSouth Shelby
Facility name
Provider ID
P000000623
NPI
1487606323
Tax ID
651128122
Effective Date
12/1/2001
Last Updated
6/6/2014
Direct Contract
Yes
Term Date
6/20/2013
Status
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
224 1st Street North Suite 150
Alabaster, AL 35007
United States
County
Shelby
Phone
2056634674
(
Phone
)
Billing Details
Address
P.O. Box 932545
Atlanta, GA 31193
Billing Phone
2059959899
Specialty Type
Radiology, Diagnostic
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Address