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
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
Specialty Type
Radiology, Diagnostic
Map
Address