Provider Directory 2008 Coventry Health Care. All rights reserved.

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Transcription:

Provider Directory

Provider Directory Table of Contents UNDERSTANDING YOUR HEALTH PLAN...2 SERVICE AREA MAP...3 PARTICIPATING HOSPITALS...4 URGENT CARE CENTERS...6 CONVENIENCE CARE CLINICS...8 ANCILLARY PROVIDERS...9 PROVIDERS...35 CHIROPRACTIC PROVIDERS...219 ROUTI VISION PROVIDERS...226 PARTICIPATING PHARMACIES...228 MENTAL HEALTH/SUBSTANCE ABUSE...229 PROVIDER INDEX...230

CHOOSING YOUR PRIMARY CARE PHYSICIAN Your Primary Care Physician (PCP) acts as your personal physician coordinating all of your health care needs. Our plans are Open Access, which means you can self-refer to an in-network PCP or specialist. You can all have the same doctor or different ones - it s your choice! Chances are, your family doctor is participating with Coventry Health Care of Georgia, Inc. If you do not see your Provider listed in this Directory, please refer to our website at www.chcga.com for the most current listing. WHAT IF I ED TO SEE A SPECIALIST? Again, our plans are Open Access and do not require a referral to see an in-network specialist. However, we recommend keeping your PCP informed whenever you seek care from other providers even if a referral is not required. WHAT IF I ED HOSPITAL CARE? Your participating physician and admitting facility are responsible for obtaining authorization from Coventry Health Care and arranging hospital care for you. Before an elective admission, it is your responsibility to ensure that you are receiving covered services and the authorization has been obtained. To confirm your authorization, please contact Customer Service at the number listed on the back of your member ID card. Please be aware that your financial responsibility will depend upon the participation status of the facility. WHAT SHOULD I DO IN AN EMERGENCY? As a member, you are covered for medical emergencies that occur when you are in or out of our service area. A medical emergency is any medical condition that would cause a prudent person, having average medical knowledge, to believe that a failure to obtain immediate medical help would place their health in serious jeopardy or result in a serious impairment or dysfunction of bodily functions, organs or parts. In a medical emergency, go to the nearest emergency room, or dial 911 for treatment. We recommend following up with your PCP after receiving emergency services. (To receive benefits, follow-up care should be coordinated within the Coventry network.) CONVENIENCE CARE AND URGENT CARE Some illnesses and injuries do not require an emergency room visit. Before seeking treatment for conditions like sprains, sore throat, cold, flu, minor cuts, rashes, or stomach problems, call your doctor first to find out whether a trip to an emergency room is necessary or if you could be treated at the doctor s office, local convenience care clinic or urgent care center. Refer to Page 8 in the Directory for network Convenient Care Clinics and refer to Page 6 for a list of network Urgent Care Centers. DO I ED MY IDENTIFICATION CARD? To receive full benefits, you must show your member identification card at the time you receive medical services. This will help avoid confusion and billing problems. Also, when you make an appointment, be sure to identify yourself as a Coventry Health Care of Georgia member. WHEN DO I PAY MY COPAYMENT/ COINSURANCE/ DEDUCTIBLE? Please pay your copayment at the provider s office when you receive medical care. Your provider may choose to collect some or all of your coinsurance or deductible payments at the time of service. QUESTIONS? Customer Service is available to assist you whenever you have a question about our network of providers or your benefits. Please note that providers have been added or deleted since this directory was printed. For the most current listing, please visit our website at www.chcga.com. You may also call Customer Service at the phone number listed on your member ID card. Representatives are available to answer your questions, Monday Friday, from 7 a.m. 6 p.m. 2

Marketing Area Heard Floyd Haralson Polk Bartow Cherokee Dawson White Paulding Cobb Douglas Coweta Fulton Spalding Henry Newton Morgan Walton Barrow Jackson Banks Hall Gwinnett Dekalb Clayton Rockdale Fayette Forsyth Oconee Clarke Madison Oglethorpe Bulloch Effingham Chatham Bryan Liberty Lumpkin Gordon Pickens Gilmer Carroll Butts Jasper Monroe Lamar Jones Bibb Crawford Peach Houston Twiggs Wilkinson Bleckley Columbia Richmond Screven Evans Long Appling Brantley Pierce Ware Atkinson Chattooga Emanuel Candler Greene Wayne Toombs Montgomery Treutlen Habersham Meriwether Pike Taylor Macon Dooly McDuffie Burke Tattnall CHC_12012008

Participating Hospitals AIKEN COUNTY, SC Aiken Regional Medical Centers 302 University Pkwy Aiken, SC 29801 (803) 641-5000 APPLING COUNTY, Appling Healthcare System 163 E Tollison St Baxley, 31513 (912) 367-9841 BUTTS COUNTY, Sylvan Grove Hospital 1050 McDonough Rd Jackson, 30233 (770) 775-7861 CANDLER COUNTY, Candler County Hospital 400 Cedar St Metter, 30439 (912) 685-5741 CLAYTON COUNTY, Southern Crescent Hospital for Specialty Care 11 Upper Riverdale Rd SW 6th Floor (770) 897-7600 Southern Regional Medical Center 11 Upper Riverdale Rd SW (770) 991-8000 Emory University Hospital 1364 Clifton Rd (404) 712-2000 DODGE COUNTY, Dodge County Hospital 901 Griffin Ave Eastman, 31023 (478) 448-4000 DOUGLAS COUNTY, The Specialty Hospital 304 Turner McCall Blvd SW (706) 509-4100 FORSYTH COUNTY, Northside Hospital Forsyth 1200 Baptist Medical Center Dr (770) 844-3200 FULTON COUNTY, BARROW COUNTY, Barrow Community Hospital 316 N Broad St Winder, 30680 (770) 867-3400 BARTOW COUNTY, Cartersville Medical Center 960 Joe Frank Harris Pkwy SE P.O. Box 200008 Cartersville, 30120 (770) 382-1530 BIBB COUNTY, Medical Center of Central Georgia (478) 633-1000 BLECKLEY COUNTY, Bleckley Memorial Hospital 145 E Peacock St Cochran, 31014 (912) 934-6211 BULLOCH COUNTY, East Georgia Regional Med Ctr 1499 Fair Rd Statesboro, 30458 (912) 486-1000 BURKE COUNTY, Burke Medical Center 351 S Liberty St Waynesboro, 30830 (706) 554-4435 CARROLL COUNTY, Tanner Medical Center 705 Dixie St Carrollton, 30117 (770) 836-9666 Tanner Medical Ctr-Villa Rica 601 Dallas Hwy Villa Rica, 30180 (770) 456-3100 CHATHAM COUNTY, Candler Hospital 5353 Reynolds St (912) 819-6000 Sempercare Hospital of Savannah, Inc. 5353 Reynolds St (912) 819-7972 St. Joseph's/Candler Hlth Syst 11705 Mercy Blvd Savannah, 31419 (912) 819-4100 CHEROKEE COUNTY, Northside Hospital - Cherokee 201 Hospital Rd Canton, 30114 (770) 720-5100 CLARKE COUNTY, St. Mary's Health Care System 1230 Baxter St (706) 389-3000 COBB COUNTY, Emory-Adventist Hospital 3949 S Cobb Dr SE Smyrna, 30080 (770) 436-3162 WellStar Cobb Hospital 3950 Austell Rd (770) 732-4000 WellStar Kennestone Hospital 677 Church St (770) 793-5000 WellStar Windy Hill Hospital 2540 Windy Hill Rd SE Marietta, 30067 (770) 644-1000 COWETA COUNTY, Newnan Hospital-West 60 Hospital Rd Newnan, 30263 (770) 253-1912 DE KALB COUNTY, Children's Healthcare of Atlanta at Egleston 1405 Clifton Rd (404) 785-6000 Decatur Hospital 450 N Candler St Decatur, 30030 (404) 501-6700 DeKalb Medical Center 2701 N Decatur Rd (404) 501-5200 DeKalb Medical Center - Hillandale 2801 Dekalb Medical Pkwy Lithonia, 30058 (404) 501-8100 WellStar Douglas Hospital 8954 Hospital Dr Frnt (770) 949-1500 EFFINGHAM COUNTY, Effingham Hospital 459 Ga Highway 119 S Springfield, 31329 (912) 754-6451 EMANUEL COUNTY, Emanuel County Hospital 117 Kite Rd Swainsboro, 30401 (478) 289-1100 EVANS COUNTY, Evans Memorial Hospital 200 N River St Claxton, 30417 (912) 739-5000 FAYETTE COUNTY, Piedmont Fayette Hospital 1255 Hwy 54, W (770) 719-7070 FLOYD COUNTY, Floyd Medical Center 304 Turner McCall Blvd SW (706) 509-6900 Redmond Regional Medical Ctr 501 Redmond Rd NW (706) 291-0291 Atlanta Medical Center 303 Parkway Dr Atlanta, 30312 (404) 265-4000 Children's Healthcare Atlanta 1001 Johnson Ferry Rd (404) 256-5252 Crawford Long Hosp Emory Univ 550 Peachtree St (404) 686-4411 Emory Johns Creek Hospital 6325 W Johns Xing Duluth, 30097 (678) 474-7000 Grady Memorial Hospital 80 Butler Street SE Hughes Spalding Children's Hospital 35 Jesse Hill Jr Dr SE (404) 785-9500 North Fulton Regional Hospital 3000 Hospital Blvd (770) 751-2500 Northside Hospital 1000 Johnson Ferry Rd (404) 851-8000 Piedmont Hospital 1968 Peachtree Rd NW (404) 605-3059 Saint Joseph's Hosp of Atlanta 5665 Peachtree Dunwoody Rd (404) 851-7001 Shepherd Center 2020 Peachtree Rd NW (404) 352-2020 4

Participating Hospitals Participating Hospitals South Fulton Medical Center 1170 Cleveland Ave Atlanta, 30344 (404) 466-1105 GILMER COUNTY, North Georgia Medical Center 1362 S Main St Ellijay, 30540 (706) 276-4741 GORDON COUNTY, Gordon Hospital 1035 Red Bud Rd Calhoun, 30701 (706) 629-2895 GREE COUNTY, Minnie G Boswell Mem Hospital 1201 Siloam Rd Greensboro, 30642 (706) 453-7331 GWINTT COUNTY, Emory Eastside Medical Center 1700 Medical Way (770) 979-0200 Gwinnett Hospital System 1000 Medical Center Blvd (770) 995-4321 Joan Glancy Memorial Hospital 3215 McClure Bridge Rd Duluth, 30096 (678) 584-6800 HALL COUNTY, Northeast Georgia Medical Center-Lanier Park Campus 675 White Sulphur Rd (678) 343-4000 Northeast Georgia Medical Ctr 743 Spring St (770) 535-3553 HARALSON COUNTY, TMC/Higgins General Hospital 200 Allen Memorial Dr Bremen, 30110 (770) 537-5851 HENRY COUNTY, Henry Medical Center 1133 Eagles Landing Pkwy (678) 604-1000 HOUSTON COUNTY, Houston Medical Center 1601 Watson Blvd Warner Robins, 31093 (912) 922-4281 Perry Hospital 1120 Morningside Dr Perry, 31069 (478) 987-3600 JACKSON COUNTY, BJC Medical Center 70 Medical Center Dr Commerce, 30529 (706) 335-1000 JASPER COUNTY, Jasper Memorial Hospital 898 College St Monticello, 31064 (706) 468-6411 LIBERTY COUNTY, Liberty Regional Medical Ctr 462 E G Parkway Hinesville, 31313 (912) 369-9400 LOWNDES COUNTY, South Georgia Medical Center 2501 N Patterson St Valdosta, 31602 (229) 333-1020 LUMPKIN COUNTY, Chestatee Regional Hospital 227 Mountain Dr Dahlonega, 30533 (706) 864-6136 MCDUFFIE COUNTY, McDuffie Regional Medical Ctr 521 W Hill St Thomson, 30824 (706) 595-1411 MERIWETHER COUNTY, Warm Springs Medical Center 5995 Spring St Warm Springs, 31830 (706) 655-3331 MONROE COUNTY, Monroe County Hospital 88 Martin Luther King Jr Dr Forsyth, 31029 (912) 994-2521 MORN COUNTY, Morgan Memorial Hospital Canterbury Park Madison, 30650 (706) 342-1667 MUSCOGEE COUNTY, The Medical Center 710 Center St Columbus, 31901 (706) 571-1000 WTON COUNTY, Newton Medical Center 5126 Hospital Dr Covington, 30014 (770) 786-7053 PAULDING COUNTY, WellStar Paulding Hospital 600 W Memorial Dr Dallas, 30132 (770) 445-4411 PEACH COUNTY, Peach Regional Medical Center 601 N Camellia Blvd Fort Valley, 31030 (478) 825-4444 PICKENS COUNTY, Mountainside Medical Center 1266 Highway 515 S Jasper, 30143 (706) 692-2441 POLK COUNTY, Polk Medical Center 424 N Main St Cedartown, 30125 (770) 748-2500 RICHMOND COUNTY, Doctors Hospital 3651 Wheeler Rd Augusta, 30909 (706) 651-3232 Medical Clg of Georgia Hosp (706) 721-2273 St. Joseph Hospital 2260 Wrightsboro Rd Augusta, 30904 (706) 481-7000 University Health Care System 1350 Walton Way (706) 722-9011 ROCKDALE COUNTY, Rockdale Hospital & Hlth Syst 1412 Milstead Ave Conyers, 30012 (770) 918-3000 SCREVEN COUNTY, Screven County Hospital 215 Mims Rd Sylvania, 30467 (912) 564-7426 SPALDING COUNTY, Spalding Regional Hospital 601 S 8th St Griffin, 30224 (770) 229-6466 TATTNALL COUNTY, Tattnall Memorial Hospital Route 1 Reidsville, 30453 (912) 557-4731 TOOMBS COUNTY, Meadows Regional Medical Ctr 1703 Meadows Ln Vidalia, 30474 (912) 537-8921 WALTON COUNTY, Walton Medical Center 330 Alcovy St Monroe, 30655 (770) 267-8461 WARE COUNTY, Satilla Regional Medical Ctr 410 Darling Ave Waycross, 31501 (912) 283-3030 WAY COUNTY, Wayne Memorial Hospital 865 S 1st St Jesup, 31545 (912) 427-6811 5

Urgent Care Centers BIBB COUNTY, Med Center - East 1339 Gray Hwy Macon, 31211 (478) 749-9200 Med Center - North 3400 Riverside Dr Macon, 31210 (478) 474-5600 Med Center - West 711 Eisenhower Pkwy Macon, 31206 (478) 474-6900 Med Center-Northwest 5925 Zebulon Rd Macon, 31210 (478) 757-7965 Pediatrics After Hours 3400 Riverside Dr Macon, 31210 (706) 660-2695 CHATHAM COUNTY, Concentra Urgent Care 109 Minis Ave Suite C-10 Savannah, 31408 (912) 966-5445 Georgia Emergency Associates Immediate Care Center 361 Commercial Dr Savannah, 31406 (912) 691-1533 CHATTOO COUNTY, Floyd Urgent Care 11766 Highway 27 Summerville, 30747 (706) 857-1010 CHEROKEE COUNTY, Immediate MedCare of Woodstock 12926 Highway 92 0 Woodstock, 30188 (770) 771-5600 Physicians' Immediate Med of Canton PC 720 Transit Ave Canton, 30114 (770) 720-7000 WellStar Urgent Care at Towne Lake, LLC 120 Stonebridge Pkwy (678) 494-2500 CLAYTON COUNTY, Children's Healthcare of Atlanta at Mount Zion 2201 Mount Zion Pkwy Morrow, 30260 (404) 785-8660 COBB COUNTY, Children's Healthcare of Atlanta at Town Center 2985 George Busbee Pkwy NW Kennesaw, 30144 (404) 785-8010 Concentra Urgent Care 220 Cobb Pkwy N Ste 400 Marietta, 30062 (770) 424-7125 Physicians' Immediate Med 2481 George Busbee Pky Kennesaw, 30144 (770) 423-0000 WellStar Urgent Care in Kennesaw, LLC 3805 Cherokee St NW Kennesaw, 30144 (770) 426-5665 WellStar Urgent Care on Delk Road, LLC 2890 Delk Rd SE Marietta, 30067 (770) 955-8620 WellStar Urgent Care on Sandy Plains Road, LLC 3600 Sandy Plains Rd Marietta, 30066 (770) 977-4547 COLUMBIA COUNTY, University Hospital Prompt Care Columbia County 447 N Belair Rd Evans, 30809 (706) 854-2222 COWETA COUNTY, Summit Healthplex 1755 Highway 34 E Newnan, 30265 (770) 502-2121 DAWSON COUNTY, Physicians' Immediate Med of Dawsonville, P.C. 91 Nordson Overlook Dawsonville, 30534 (706) 216-6000 DE KALB COUNTY, Community Care, PC 5019 Lavista Rd Tucker, 30084 (404) 501-3270 Emory Student Health Center 2711 Irvin Way Suite 111 Decatur, 30030 (404) 712-7041 Hillandale Minor Emergency Center 5910 Hillandale Dr Suite 103 Lithonia, 30058 (770) 981-2443 ICCS dba Toco Hills Urgent Care 3019 N Druid Hills Rd Atlanta, 30329 (404) 325-2100 5921 New Peachtree Rd Atlanta, 30340 (404) 325-2100 DOUGLAS COUNTY, Physicians' Immediate Med of Douglasville PC 9390 The Landing Dr Douglasville, 30135 (770) 947-1112 TMC Immediate Care, Inc. 9280 Highway 5 Ste E (770) 949-7500 EFFINGHAM COUNTY, Effingham Hospital MedCare 100 Goshen Rd Rincon, 31326 (912) 826-6000 FLOYD COUNTY, Floyd Urgent Care 304 Shorter Ave NW (706) 291-3700 FULTON COUNTY, Children's Healthcare of Atlanta at North Point 3795 Mansell Rd Alpharetta, 30022 (404) 785-8540 Concentra Urgent Care 3580 Atlanta Ave Atlanta, 30354 (404) 768-3351 Physicians' Immediate Med 10905 Haynes Bridge Rd Alpharetta, 30022 (770) 505-3000 U.S. Healthworks Medical Group of Georgia, PC 900 Holcomb Bridge Rd (770) 998-0605 GWINTT COUNTY, Children's Healthcare of Atlanta at Satellite Blvd 2660 Satellite Blvd Duluth, 30096 (404) 785-8330 Concentra Urgent Care 1905 Beaver Ruin Rd Ste 175 Norcross, 30071 (770) 441-0444 Physicians' Immediate Med 3551 Satellite Blvd Duluth, 30096 (770) 476-3000 3720 Holcomb Bridge Rd Norcross, 30092 (770) 263-1000 Physicians' Immediate Med of Buford, P.C. 3425 Buford Dr Buford, 30519 (678) 546-0200 Premier Immediate Care of Georgia, PC 2696 Lawrenceville Suwanee Rd (678) 376-1300 289 Grayson Hwy (678) 376-1300 HALL COUNTY, Guilford Immediate Care 1250 Jesse Jewell Pkwy SE Suite 400 (770) 532-0800 Urgent Care Friendship 4889 Golden Pkwy Buford, 30518 (678) 714-3217 HENRY COUNTY, Brightpoint Urgent Care, LLC 1365 Rock Quarry Rd (770) 692-5910 Minor Emergency Care 101 Regency Park Dr Mcdonough, 30253 (770) 957-0035 Spalding Regional Urgent Care Center at Heron Bay L.L.C. 3334 Highway 155 Locust Grove, 30248 (678) 583-0241 HOUSTON COUNTY, Houston Lake Med- Stop 2510 Hwy 127 Kathleen, 31047 (478) 988-1865 Pavillion Med-Stop 233 N Houston Rd Warner Robins, 31093 (478) 923-2843 6

Urgent Care Centers Polk LOWNDES COUNTY, Convenient Care - Valdosta 2330 N Ashley St Valdosta, 31602 (229) 249-5080 MUSCOGEE COUNTY, Regional Urgent Care 1800 10th Ave Ste F Columbus, 31901 (706) 320-8686 PAULDING COUNTY, Physicians' Immediate Med of Hiram PC 3827 Jimmy Lee Smith Pkwy Hiram, 30141 (770) 222-8900 POLK COUNTY, Floyd Urgent Care 1025 N Main St Cedartown, 30125 (770) 748-0076 7

Convenience Care Clinics CHEROKEE COUNTY, MinuteClinic Diagnostic of Georgia, LLC 1600 Towne Lake Pkwy (866) 389-2727 3785 Sixes Rd Canton, 30114 (866) 389-2727 6120 Hickory Flat Hwy Canton, 30115 (866) 389-2727 COBB COUNTY, MinuteClinic Diagnostic of Georgia, LLC 2014 Powers Ferry Rd SE Atlanta, 30339 (866) 389-2727 2994 Atlanta Rd SE Smyrna, 30080 (866) 389-2727 3070 N Main St NW Kennesaw, 30144 (866) 389-2727 3905 Due West Rd NW Marietta, 30064 (866) 389-2727 4200 Paces Ferry Rd SE Atlanta, 30339 (866) 389-2727 Take Care Health Georgia, PC 1762 Mars Hill Rd NW Acworth, 30101 (866) 825-3227 2464 Roswell Rd Marietta, 30062 (866) 825-3227 2779 Cobb Pkwy NW Kennesaw, 30152 (866) 825-3227 2988 Shallowford Rd Marietta, 30066 (866) 825-3227 4120 Austell Rd (866) 825-3227 Take Care Health Georiga, PC 2670 Cobb Pkwy SE Smyrna, 30080 (866) 825-3227 COWETA COUNTY, MinuteClinic Diagnostic of Georgia, LLC 2305 Highway 34 E Newnan, 30265 (866) 389-2727 DE KALB COUNTY, MinuteClinic Diagnostic of Georgia, LLC 2738 N Decatur Rd (866) 389-2727 5764 Peachtree Industrial Blvd Atlanta, 30341 (866) 389-2727 7207 Rockbridge Rd Stone Mountain, 30087 (866) 389-2727 Take Care Health Georgia, PC 5230 Memorial Dr Stone Mountain, 30083 (866) 825-3227 Take Care Health Georiga, PC 2945 Panola Rd Lithonia, 30038 (866) 825-3227 DOUGLAS COUNTY, MinuteClinic Diagnostic of Georgia, LLC 6031 Fairburn Rd (866) 389-2727 Take Care Health Georgia, PC 9465 Highway 5 Douglasville, 30135 (866) 825-3227 FAYETTE COUNTY, MinuteClinic Diagnostic of Georgia, LLC 100 Carriage Oaks Dr Tyrone, 30290 (866) 389-2727 101 Lexington Cir Peachtree City, 30269 (866) 389-2727 FORSYTH COUNTY, MinuteClinic Diagnostic of Georgia, LLC 5370 Laurel Springs Pkwy (866) 389-2727 FULTON COUNTY, MinuteClinic Diagnostic of Georgia, LLC 1380 Woodstock Rd Roswell, 30075 (866) 389-2727 2429 Martin Luther King Jr Dr SW Atlanta, 30311 (866) 389-2727 6300 Powers Ferry Rd NW Atlanta, 30339 (866) 389-2727 7055 Old National Hwy Riverdale, 30296 (866) 389-2727 865 N Highland Ave Atlanta, 30306 (866) 389-2727 895 Holcomb Bridge Rd (866) 389-2727 MinuteClinic Diagnostic of Gerogia, LLC 11710 Alpharetta Hwy (866) 389-2727 Take Care Health Georgia, PC 3003 Old Alabama Rd Alpharetta, 30022 (866) 825-3227 7530 Roswell Rd Atlanta, 30350 (866) 825-3227 GWINTT COUNTY, MinuteClinic Diagnostic of Georgia, LLC 1950 Buford Hwy Buford, 30518 (866) 389-2727 3027 Jim Moore Rd Dacula, 30019 (866) 389-2727 5095 Peachtree Pkwy Norcross, 30092 (866) 389-2727 5710 Sugarloaf Pkwy Lawrenceville, 30043 (866) 389-2727 Take Care Health Georgia, PC 181 S Clayton St (866) 825-3227 2990 Five Forks Trickum Rd Lawrenceville, 30044 (866) 825-3227 5985 Peachtree Pkwy Norcross, 30092 (866) 825-3227 HENRY COUNTY, MinuteClinic Diagnostic of Georgia, LLC 5095 Mount Zion Pkwy (866) 389-2727 80 Fairview Rd Ellenwood, 30294 (866) 389-2727 Take Care Health Georgia, PC 1855 Hudson Bridge Rd (866) 825-3227 WTON COUNTY, MinuteClinic Diagnostic of Georgia, LLC 4192 Salem Rd Covington, 30016 (866) 389-2727 WALTON COUNTY, MinuteClinic Diagnostic of Georgia, LLC 2720 Loganville Hwy Loganville, 30052 (866) 389-2727 8

Ancillary Providers AIKEN COUNTY, SC Laboratory Quest Diagnostics-Aiken 410 University Pkwy Ste 2200 Aiken, SC 29801 (803) 502-0774 ALAMANCE COUNTY, NC Durable Medical Equipment Pediatric Services of America, Inc 2579 Eric Ln Ste. F Burlington, NC 27215 (336) 226-2334 Laboratory Quest Diagnostics- Burlington 1161 Huffman Mill Rd Burlington, NC 27215 (336) 584-0927 Rehabilitation Therapy Facility HealthSouth-Burlington 422 Huffman Mill Rd Ste 210-211 Burlington, NC 27215 (336) 584-7400 APPLING COUNTY, Durable Medical Equipment Certified Respiratory Services, Inc. 88 Heritage St Baxley, 31513 (912) 366-9226 BALDWIN COUNTY, Dialysis Center Milledgeville Dialysis 400 S Wayne St Milledgeville, 31061 (478) 453-9489 Durable Medical Equipment Georgia Medical Equipment and Respiratory Services, Inc. 1891 N Columbia St Suite 109 Milledgeville, 31061 (478) 451-5185 Laboratory Quest Diagnostics-Fairhope 312 S Greeno Rd Fairhope, AL 36532 (251) 990-0717 BANKS COUNTY, Dialysis Center Fresenius Medical Care River City 2443 brookstone court ste B Columbus, 31904 (706) 327-6350 BARROW COUNTY, Dialysis Center Barrow County Dialysis Center 189 W Athens St Ste 9 Winder, 30680 (770) 868-8517 Physical, Speech, Occup Therapy Physiotherapy Associates 137 N Broad St Ste E Winder, 30680 (770) 307-3922 Radiology Barrow Community Hospital 316 E Broad St P O Box 688 Winder, 30680 (770) 307-5280 Georgia Pain Spine Center 15 Medical Dr Ste 302 Cartersville, 30121 (678) 741-2115 Dialysis Center BMA-Cartersville 14 Roving Rd Cartersville, 30121 (770) 386-8168 Durable Medical Equipment Apria Healthcare, Inc. 945 Joe Frank Harris Pkwy SE Cartersville, 30120 (770) 387-1075 Fuller Rehabilition Independent Living Aids- Cartersville 440 Cherokee Pl Cartersville, 30121 (770) 607-5292 Hanger Prosthetics & Orthotics, Inc. 17B Felton Pl Cartersville, 30120 (770) 387-7656 Phillips Medical Equipment, LLC 144 Kelli Clark Ct SE Cartersville, 30121 (678) 574-6313 Home Health Agency Healthfield Home Health Inc 321 N Main St Adairsville, 30103 (770) 773-2779 Physical, Speech, Occup Therapy BenchMark Physical Therapy 939 Joe Frank Harris Pkwy SE Cartersville, 30120 (770) 383-9734 Prosthetics/Orthotics Apria Healthcare, Inc. 945 Joe Frank Harris Pkwy SE Cartersville, 30120 (770) 387-1075 Hanger Prosthetics & Orthotics, Inc. 17B Felton Pl Cartersville, 30120 (770) 387-7656 Radiology Cartersville Diagnostic Center, LLC 21 Pointe North Dr Ste 105 Cartersville, 30120 (770) 383-8830 Reed Imaging Services LLC 15 Medical Dr Ste 102 Cartersville, 30121 (678) 605-9009 Rehabilitation Therapy Facility Advance Rehabilitation of Adairsville 10 Legacy Way Ste E Adairsville, 30103 (770) 773-9315 Quest Diagnostics-Bluffton 25 Sheridan Dr Bluffton, SC 29910 (843) 706-2413 Quest Diagnostics-Hilton Head 94 Main St Ste D Hilton Head Island, SC 29926 (843) 342-5014 BEN HILL COUNTY, Prosthetics/Orthotics Southern Physical & Occupational Therapy Services Inc 112 N Main St P O Box 557 Fitzgerald, 31750 (229) 423-8403 BERKELEY COUNTY, SC Dialysis Center Gambro Healthcare-Moncks Corner 642 RC Dennis Blvd Moncks Corner, SC 29461 (843) 899-4953 BIBB COUNTY, Ambulatory Surgery Center ANDERSON COUNTY, SC Home Health Agency Pediatric Services of America, Inc 114 Commons Blvd STe. C Piedmont, SC 29673 (864) 295-8655 Medical Imaging A Diagnostic Radiology Network Facility 1850 N Columbia St Suite 3 Milledgeville, 31061 (800) 953-5510 Physical Therapy Serenity Wellness Spa 107 Sportsman Club Rd Milledgeville, 31061 (478) 453-0041 Sleep Disorders Preferred Diagnostic Sleep Centers, Inc. Barrow Medical Ctr 316 N Broad St (Hwy 81) Winder, 30680 (770) 761-8468 BARTOW COUNTY, Ambulatory Surgery Center Center for Orthopedic Surgery 15 Medical Dr Cartersville, 30121 (770) 386-5221 Hospice In Home Health, Inc 319 E Church St Cartersville, 30120 (770) 382-0721 Occupational Therapy Hand Therapy Services 5 Medical Dr Cartersville, 30121 (706) 397-2809 Physical Therapy Rehab Associates 695 Henderson Dr Cartersville, 30120 (770) 386-6300 BEAUFORT COUNTY, SC Durable Medical Equipment Crutches & Such As 990 Ribaut Rd Suite 101 Beaufort, SC 29902 (843) 525-6994 Laboratory Quest Diagnostic - Hilton Head Island 460 William Hilton Pkwy Hilton Head Island, SC 29926 (843) 681-4780 Central Georgia Head & Neck Surgery Center 540 Hemlock St (478) 743-8953 Endoscopy Center of Middle Georgia, LLC 610 3rd St (478) 464-2600 Macon Outpatient Surgery, LLC 840 Pine St Ste 840 (478) 745-4206 Medical Eye Associates, Inc. 1429 Oglethorpe St (478) 743-7061 Dialysis Center BMA-Macon 280 Clinton St Macon, 31217 (478) 743-9506 A member may seek services at any Ancillary Provider listed above under the direction of their Primary Care Physician(PCP) as required by their benefit plan. If PCP direction is required and the member seeks care without contacting their PCP, services may be denied. Please consult your Certificate of Coverage for full benefit information. Please visit us on the 9

Ancillary Providers Bibb Dialysis Center Dialysis Center of Middle Georgia-Macon 747 2nd St (912) 742-4211 Dialysis Treatment Centers of Macon 745 Pine St (912) 741-9810 East Macon Dialysis 750 Baconsfield Dr Ste 103 Macon, 31211 (912) 755-1144 FMC Dialysis Services-South Macon 2500 2nd St Macon, 31206 (478) 743-1243 Renal Treatment Centers- Midtown Macon Dialysis Center 657 Hemlock St (912) 746-6855 Durable Medical Equipment Apria Healthcare, Inc. 182 Steven Dr Macon, 31210 (478) 757-8196 C.H. Martin 130 College St (478) 742-4331 ChiChesters Homecare Inc. 1042 Gray Hwy Macon, 31211 (478) 743-4557 DJO, LLC 291 Plantation Centre Dr N Suite 1907 Macon, 31210 (800) 321-9549 Lincare, Inc 770 Baconsfield Dr Bldg 1, Macon, 31211 (478) 841-2772 Mediquip Rehabilitative Equipment & Supplies 808 Pio Nono Ave Macon, 31204 (478) 742-1300 Pediatric Services of America 770 Baconsfield Dr Bldg 1, Macon, 31211 (478) 841-2772 Pediatric Services of America, Inc 770 Baconsfield Dr Building 1, Ste. 100 Macon, 31211 (478) 841-2772 SleepMed Incorporated (478) 633-7222 SleepMed, Inc 770 Hemlock St (800) 846-2973 Southern Home Respiratory Care 466 Poplar St (478) 746-9760 Home Health Agency Central Georgia Home Care Services, Inc 3780 Eisenhower Pky Ste 5 Macon, 31206 (478) 633-5700 Pediatric Services of America, Inc 770 Baconsfield Dr Building 1, Ste. 100 Macon, 31211 (478) 841-2772 Physician Support Associates, Inc 1021 Daisy Pk (478) 746-0919 Laboratory Quest Diagnostics-Macon 446 Poplar St (478) 745-8576 Medical Imaging MedCross Imaging, PC 1818 Forsyth St (770) 507-2711 Physical, Speech, Occup Therapy Physiotherapy Associates 6501 Peake Rd Bldg 100 Macon, 31210 (478) 757-1667 Prosthetics/Orthotics Apria Healthcare, Inc. 182 Steven Dr Macon, 31210 (478) 757-8196 DJO, LLC 291 Plantation Centre Dr N Suite 1907 Macon, 31210 (800) 321-9549 Radiology Central Georgia MRI, LLC 5925 Zebulon Rd Macon, 31210 (478) 757-7877 Central Georgia PET, LLC 1650 Hardeman Ave (478) 749-9720 Children's Radiology of Atlanta 833 Walnut St (877) 442-2156 Open Macon Imaging Center 833 Walnut St (478) 741-4711 Open MRI of Macon 1504 Hardeman Ave (478) 745-3135 1650 Hardeman Ave (478) 745-3135 Open MRI of Macon, LLC 2140 Riverside Dr Macon, 31204 (478) 745-2777 Radiology Center of Macon, LLC 833 Walnut St (478) 745-2727 Sleep Disorders Sleep Services of America, Inc 215 Sheraton Blvd & B Macon, 31210 (478) 757-0759 SleepMed Incorporated (478) 633-7222 SleepMed, Inc 770 Hemlock St (800) 846-2973 Southern Sleep Technologies 466 Poplar St (478) 746-9760 BLADEN COUNTY, NC Durable Medical Equipment Pediatric Services of America, Inc 312 S Poplar Street Elizabethtown, NC 28337 (910) 862-3661 Home Health Agency Pediatric Services of America, Inc 312 S Poplar Street Elizabethtown, NC 28337 (910) 862-3661 Home IV Infusion Agency Pediatric Services of America, Inc 312 S Poplar Street Elizabethtown, NC 28337 (910) 862-3661 BRADLEY COUNTY, TN Audiology Audibel Hearing Aid Centers 1011 Keith St NW Ste 2 Cleveland, TN 37311 (423) 479-7356 Durable Medical Equipment United Medical, Inc 4681 N Lee Hwy Cleveland, TN 37312 (423) 614-8816 Hearing Aid, Sales & Repair Audibel Hearing Aid Centers 1011 Keith St NW Ste 2 Cleveland, TN 37311 (423) 479-7356 BRYAN COUNTY, Rehabilitation Therapy Facility West Rehab Services, Inc 9964 Ford Ave Richmond Hill, 31324 (912) 756-5699 West Rehab Services, Inc. 205 E Bacon St Pembroke, 31321 (912) 653-0040 BULLOCH COUNTY, Dialysis Center FMC of Bullouch County 1355 Brampton Ave Statesboro, 30458 (912) 871-2968 Renal Treatment Centers- East Georgia Dialysis 450 Georgia Ave Statesboro, 30458 (912) 871-6108 Durable Medical Equipment Apria Healthcare, Inc. 16 College Plz Statesboro, 30458 (912) 681-8208 Georgia Home Medical 606 S Zetterower Ave Statesboro, 30458 (912) 489-1180 Hanger Prosthetics & Orthotics East, Inc 144 Northside Dr E Statesboro, 30458 (912) 489-8411 Walker Home Medical 206 Northside Dr W Suite 1 Statesboro, 30458 (912) 681-3838 Home Health Agency Ogeechee Home Health Agency, Inc. 1525 Fair Rd Suite C Statesboro, 30458 (912) 764-6801 Occupational Medicine Southern Wellness and Rehab 23630 B. Highway 80 East Statesboro, 30458 (912) 764-9951 Orthotics Apria Healthcare, Inc. 16 College Plz Statesboro, 30458 (912) 681-8208 Physical Therapy Southern Wellness and Rehab 23630 B. Highway 80 East Statesboro, 30458 (912) 764-9951 Prosthetics/Orthotics Apria Healthcare, Inc. 16 College Plz Statesboro, 30458 (912) 681-8208 Radiology Statesboro Imaging Center, PC 8 Lester Rd Statesboro, 30458 (912) 764-5656 Rehabilitation Southern Sports Medicine & Rehabilitation 911 E Inman St Statesboro, 30458 (912) 764-1680 BUNCOMBE COUNTY, NC Laboratory Quest Diagnostics-Asheville 41 Oakland Rd Asheville, NC 28801 (828) 252-0706 BURKE COUNTY, Home Health Agency University Home Health Services 77 US Highway 25 S Waynesboro, 30830 (706) 554-7013 Physical, Speech, Occup Therapy University Home Health Services 77 US Highway 25 S Waynesboro, 30830 (706) 554-7013 BUTTS COUNTY, Dialysis Center Grovepark Dialysis 794 McDonough Rd Jackson, 30233 (770) 504-0365 Rehabilitation Therapy Facility HealthSouth Sports Medicine & Rehab. Center 464 W 3rd St Ste 107 Jackson, 30233 (770) 775-3991 CABARRUS COUNTY, NC Laboratory Quest Diagnostics-Concord 845 Church St N Ste 210 Concord, NC 28025 (704) 795-5311 A member may seek services at any Ancillary Provider listed above under the direction of their Primary Care Physician(PCP) as required by their benefit plan. If PCP direction is required and the member seeks care without contacting their PCP, services may be denied. Please consult your Certificate of Coverage for full benefit information. Please visit us on the 10

Ancillary Providers Chatham Durable Medical Equipment Physical, Speech, Occup Therapy HealthSouth-Concord 470 Lake Concord Rd Concord, NC 28025 (704) 782-1322 CALDWELL COUNTY, NC Durable Medical Equipment Pediatric Services of America 2024 Connley Springs Road Lenoir, NC 28645 (828) 726-1306 Home IV Infusion Agency Pediatric Services of America 2024 Connley Springs Road Lenoir, NC 28645 (828) 726-1306 CAEN COUNTY, Rehabilitation Therapy Facility Advance Rehabilitation of Kingsland 100 Lindsey Ln Kingsland, 31548 (912) 729-1333 Kingsland Physical Therapy 130 N Gross Rd Ste 202 Kingsland, 31548 (912) 882-5272 CANDLER COUNTY, Dialysis Center FMC Candler County Dialysis 380 Sconyers St Metter, 30439 (912) 685-7746 Rehabilitation Better Living Services, Inc 8 N Williams St Metter, 30439 (912) 685-4331 CARROLL COUNTY, Ambulatory Surgery Center Carrollton Eye Clinic Ambulatory Surgery Center 158 Clinic Ave Carrollton, 30117 (770) 834-1008 West Georgia Endoscopy Center 160 Clinic Ave Carrollton, 30117 (770) 214-2800 Dialysis Center Bio-Medical Applications of Carrollton 195 Parkwood Cir Carrollton, 30117 (770) 832-1322 FMCNA Villa Rica 130 Prospecter Dr Facility # 3846 Villa Rica, 30180 (770) 459-7135 Fresenius Medical Care- Carroll County 157 Clinic Ave Ste 102 Carrollton, 30117 (770) 832-2202 Home Health Agency Tanner Medical Center Home Health, Inc. 100 Professional Pl Ste 303 Carrollton, 30117 (770) 834-5438 Hospice Tanner Medical Center Hospice Care, Inc. 122 Lee St Carrollton, 30117 (770) 214-2355 Physical Therapy Accel Physical Therapy 2000 Mirror Lake Blvd Ste F, Box 160 Villa Rica, 30180 (770) 456-7877 Physical, Speech, Occup Therapy Physiotherapy Associates 100 Professional Pl Ste 108 Carrollton, 30117 (770) 834-5034 Southern Therapy Service 812 S Park St Carrollton, 30117 (770) 834-7436 Southern Therapy Services 690 Dallas Hwy Ste 203 Villa Rica, 30180 (770) 832-2484 Southern Therapy Services, Inc 99 Doctors Dr Carrollton, 30117 (770) 834-7436 Prosthetics/Orthotics American Prosthetics Inc 1004 Bankhead Hwy Ste 14 Carrollton, 30117 (770) 388-0239 Atlanta Prosthetics & Orthotics, Inc. 1124 N Park St Suite D Carrollton, 30117 (770) 214-8282 Radiology Children's Radiology of Atlanta 805 Dixie St Carrollton, 30117 (770) 442-2155 Open Carrollton Imaging Center 805 Dixie St Carrollton, 30117 (770) 214-3579 Rehabilitation Therapy Facility Matrix Rehabilitation- Georgia, Inc 1004 Bankhead Hwy Bldg A Ste 5 Carrollton, 30117 (770) 834-5609 Skilled Nursing Facility IHS at Carrollton Nursing & Rehabilitation Center 2327 N Highway 27 Carrollton, 30117 (770) 834-4404 IHS at Pine Knoll Nursing & Rehabilitation Center 156 Pine Knoll Dr Carrollton, 30117 (770) 832-8243 CATAWBA COUNTY, NC Laboratory Quest Diagnostics-Hickory 1771 Tate Blvd SE Hickory, NC 28602 (828) 322-8034 CATOOSA COUNTY, Durable Medical Equipment American Home Patient 435 Cloud Springs Rd Rossville, 30741 (706) 861-0903 American Homepatient 435 Cloud Springs Rd Rossville, 30741 (229) 257-0075 Fuller Rehabilition Independent Living Aids 529 Rollins Industrial Blvd Ringgold, 30736 (706) 965-4430 Oxygen & More 11 S Commerce Dr Ringgold, 30736 (706) 861-1766 Physical, Speech, Occup Therapy BenchMark Physical Therapy-Fort Oglethorpe 1394 Battlefield Pkwy Fort Oglethorpe, 30742 (706) 858-0252 CHARLESTON COUNTY, SC Laboratory Quest Diagnostics- Charleston-West Ashley 1843 Ashley River Rd Charleston, SC 29407 (843) 571-6377 CHARLTON COUNTY, Rehabilitation Advance Rehabilitation of Folkston 1203 N 3rd St Folkston, 31537 (912) 496-7842 CHATHAM COUNTY, Ambulatory Surgery Center Endoscopy Center of Coastal Georgia 519 Stephenson Ave (912) 354-9447 ENT Surgical Center 13040 Abercorn St Ste 2 Savannah, 31419 (912) 920-6911 Georgia Center for Digestive Diseases, LLC 501 Eisenhower Dr Savannah, 31406 (912) 354-2175 Orthopedic Surgery Center 210 E De Renne Ave (912) 644-5343 Plastic Surgery Centerland 5361 Reynolds St (912) 355-8000 Savannah Outpatient Foot & Ankle Surgery Center 310 Eisenhower Dr Building 7B Savannah, 31406 (912) 356-8440 Savannah Pain Center, LLC 8 Wheeler St ste 200 (912) 352-4340 Schulze Surgery Center 728 E 67th St (912) 352-3120 Shankliln Plastic Surgery Center, LLC 900 Mohawk St Savannah, 31419 (912) 920-2090 The Endoscopy Center, LLC 1139 Lexington Ave Savannah, 31404 (912) 303-4200 Urology Surgery Center of Savannah, LLLP 230 E De Renne Ave (912) 790-4444 Audiology Coastal Audiology, Inc 138 Canal St Ste 108 Pooler, 31322 (912) 748-9494 Dialysis Center Bio-Medical Applications Coastal Dialysis Center 1460 E Victory Dr Savannah, 31404 (912) 232-2691 RAI Drayton Savannah 1020 Drayton St Savannah, 31401 (912) 233-6067 West Chatham Dialysis Center 343 Main St Savannah, 31408 (912) 965-0305 Durable Medical Equipment American Homepatient 7602 Waters Ave Savannah, 31406 (912) 353-7400 Apria Healthcare, Inc. 901 E 65th St (912) 352-4651 C.H. Martin 7135 Hodgson Memorial Dr Ste 1-B Savannah, 31406 (912) 352-1199 Coastal Home Respiratory 409 E Montgomery Xrd Ste 5A Savannah, 31406 (912) 925-5572 Coastal Therapy, Inc. 911 E 70th St (912) 355-0123 Fuller Rehabilition Independent Living Aids- Savannah 11706 Mercy Blvd Bldg 3 Savannah, 31419 (912) 961-9555 Medi Home Advantage 5353 Reynolds St Ste 107 (912) 443-6051 Medi Home Care 4131 Ogeechee Rd Ste 123 (912) 443-6051 7001 Chatham Center Dr Ste 2200 (912) 692-7400 Medical Infusion Technologies, Inc 115 Echols Ave Savannah, 31406 (912) 691-0333 Peachtree Medical Equipment 3326 Skidaway Rd Savannah, 31404 (912) 354-4522 Pediatric Services of America, Inc 37 W Fairmont Ave Unit 204 Savannah, 31406 (912) 961-1017 Renewal At Lewis Center/St Joseph/Candler Hosp 225 Candler Rd Ste 102 (912) 719-9900 Savannah Orthotics & Prosthetics, Inc. 906 E 68th St (912) 355-7778 Sleep Well, LLC 340 Hodgson Ct Bldg 200 Ste 2 Savannah, 31406 (912) 356-5986 Walker Home Medical 1100 Eisenhower Dr Suite 19 Savannah, 31406 (912) 681-3838 A member may seek services at any Ancillary Provider listed above under the direction of their Primary Care Physician(PCP) as required by their benefit plan. If PCP direction is required and the member seeks care without contacting their PCP, services may be denied. Please consult your Certificate of Coverage for full benefit information. Please visit us on the 11

Ancillary Providers Chatham Hearing Aid, Sales & Repair Hearing Aid, Sales & Repair Savannah Speech and Hearing Center 1206 E 66th St Savannah, 31404 (912) 355-4601 Home Health Agency American Homepatient 7602 Waters Ave Savannah, 31406 (912) 353-7400 Gentiva Health Services Inc 329 Commercial Dr Ste 130 Savannah, 31406 (912) 355-3409 Healthcare Principals Group, LLC 138 Canal St Ste.207 Pooler, 31322 (912) 748-6580 Pediatric Services of America, Inc 37 W Fairmont Ave Unit 204 Savannah, 31406 (912) 961-1017 Secure Care, Inc. 351 Commercial Dr Savannah, 31406 (912) 356-5469 St. Joseph's Candler Home Healthcare 5510 Paulsen St (912) 819-7600 Laboratory Quest Diagnostics - Savannah 340 Eisenhower Dr Ste 1480 Savannah, 31406 (912) 354-0664 Quest Diagnostics- Savannah 340 Eisenhower Dr Ste 1480 Savannah, 31406 (912) 354-0664 Quest Diagnostics- Savannah Medical District 815 E 68th St (912) 691-2208 Medical Imaging Boland Women's Imaging PC 1615 E Montgomery Xrd Savannah, 31406 (912) 352-2299 Occupational Therapy Pediatric Therapies of Savannah 6555 Abercorn St ste 221 (912) 354-4474 Physical, Speech, Occup Therapy Radiology Associates of Savannah, PC 5105 Paulsen St Suite C140 (912) 355-8188 Savannah Chatham Imaging Services 11705 Mercy Blvd Savannah, 31419 (912) 303-0165 Rehabilitation Recovery Place 835 E 65th St (912) 355-1440 Rehabilitation Therapy Facility West Rehab Services Inc 1000 Towne Center Blvd Ste 602 Pooler, 31322 (912) 330-0155 West Rehab Services, Inc 109-C Minus Ave Savannah, 31408 (912) 964-6525 West Rehab Services, Inc. 100 Blue Fin Cir Ste 3 Savannah, 31410 (912) 897-1114 315 Eisenhower Dr Savannah, 31406 (912) 353-9378 Skilled Nursing Facility CHATTOO COUNTY, Dialysis Center Harbin Clinic Summerville Dialysis Center 12541 Highway 27 Summerville, 30747 (706) 857-4050 Rehabilitation Therapy Facility Advance Rehabilitation & Consulting, Inc 11638 Highway 27 Ste 1 Summerville, 30747 (706) 857-6366 CHEROKEE COUNTY, Ambulatory Surgery Center Woodstock Endoscopy Center, LLC 2001 Professional Way Ste 270 Woodstock, 30188 (404) 253-6870 Audiology Durable Medical Equipment BioKinetics, Inc 3013 High Vista Walk (770) 592-5706 DJO, LLC 1131 Etowah Valley Ln (800) 321-9549 Physiotherapy Associates 720 Transit Ave ste 102 Canton, 30114 (678) 880-2840 SleepMed Incorporated 2230 Towne Lake Pkwy Bldg 1000 (770) 516-5455 Occupational Therapy Towne Lake Hand Therapy, Inc. 2230 Towne Lake Pkwy Bldg. 600 Ste 110 (770) 852-7399 Physical Therapy Woodstock Physical Therapy & Joint Medicine, LLC 1816 Eagle Dr Bldg 100, (770) 516-9191 Open Woodstock Imaging Center 2001 Professional Way Ste 160 Woodstock, 30188 (770) 395-8900 Quantum Radiology - Kennestone Towne Lake Imaging 120 Stonebridge Pkwy (678) 494-2440 Wellstar Kennestone Medical Imaging Center at Towne Lake 120 Stonebridge Pkwy (678) 494-2440 Woodstock Diagnostic Imaging 300 Parkbrooke Pl Ste 170 (678) 494-2345 Rehabilitation Therapy Facility HealthSouth Sports Medicine & Rehab. Center 230 Marietta Hwy Ste 120 Canton, 30114 (770) 720-7156 Skilled Nursing Facility IHS at Woodstock Nursing & Rehabilitation Center 105 Arnold Mill Rd Woodstock, 30188 (770) 926-0016 Home IV Infusion Agency American Homepatient 7602 Waters Ave Savannah, 31406 (912) 353-7400 Infusion Partners 1000 Business Center Dr Ste 120 (912) 232-1588 Medical Infusion Technologies, Inc 115 Echols Ave Savannah, 31406 (912) 691-0333 Venous Access Services, LLC 1 Johnston St Unit 6 (912) 354-9422 Hospice Hospice Savannah, Inc 1352 Eisenhower Dr Savannah, 31406 (912) 355-2289 Candler Hospital 5353 Reynolds St (912) 819-6000 Coastal Therapy, Inc. 911 E 70th St (912) 355-0123 St. Joseph's/Candler Hlth Syst 11705 Mercy Blvd Savannah, 31419 (912) 819-4100 Prosthetics/Orthotics Apria Healthcare, Inc. 901 E 65th St (912) 352-4651 Radiology Open MRI of Savannah 4815 Waters Ave Savannah, 31404 (912) 355-6736 PET Imaging Center of Savannah, LLC 7135 Hodgson Memorial Dr Ste 10A Savannah, 31406 (770) 692-2371 IHS at Savannah Beach Nursing & Rehabilitation Center 90 Van Horne Ave Tybee Island, 31328 (912) 786-4511 Riverview Health & Rehabilitation Center 6711 La Roche Ave Savannah, 31406 (912) 354-8225 Sleep Disorders SleepCare Institute, Inc 836 E 65th St Bldg 2 (912) 691-0031 The Sleep Disorders Center at St. Josephs Hospital 11706 Mercy Blvd Suiate 4 Savannah, 31419 (912) 927-5141 Progressive Audiology Center, Inc. 2230 Towne Lake Pkwy Bldg 800, Ste 120 (770) 592-4744 Diagnostic Facility Atlantic Diagnostic Center, LLC 720 Transit Ave Canton, 30114 (770) 794-5000 Dialysis Center FMC Dialysis Services Woodstock 100 Londonderry Ct Woodstock, 30188 (770) 592-3439 RCC Northern Georgia 411 Hospital Rd Canton, 30114 (770) 479-0259 Woodstock Dialysis 2001 Professional Pky Woodstock, 30188 (678) 494-1171 Physical, Speech, Occup Therapy BenchMark Physical Therapy 2230 Towne Lake Pkwy Bldg 1200, & 110 (770) 926-2744 Physiotherapy Associates 655 Molly Ln (770) 517-1080 Prosthetics/Orthotics DJO, LLC 1131 Etowah Valley Ln (800) 321-9549 Radiology Children's Radiology of Atlanta 2001 Professional Pky Ste 160 Woodstock, 30188 (770) 442-2155 Sleep Disorders SleepMed Incorporated 2230 Towne Lake Pkwy Bldg 1000 (770) 516-5455 CLARKE COUNTY, Ambulatory Surgery Center American Eye Surgery Center 651 S Milledge Ave Athens, 30605 (706) 546-9290 Georgia Lithotripsy & Laser Center 120 Trinity Pl Athens, 30607 (706) 543-2718 Dialysis Center Dialysis Center of Athens 210 Hawthorne Park (706) 316-3790 A member may seek services at any Ancillary Provider listed above under the direction of their Primary Care Physician(PCP) as required by their benefit plan. If PCP direction is required and the member seeks care without contacting their PCP, services may be denied. Please consult your Certificate of Coverage for full benefit information. Please visit us on the 12

Ancillary Providers Cobb Ambulatory Surgery Center Gambro Healthcare-Athens West 2047 Prince Ave (706) 546-0054 RCG Clarke County 850 Prince Ave (706) 549-6885 Durable Medical Equipment Apria Healthcare, Inc. 5095 Jefferson Rd Athens, 30607 (706) 546-4477 Fuller Rehabilition Independent Living Aids- Athens 3190 Atlanta Hwy Suite 15-A (706) 549-3777 Hanger Prosthetics & Orthotics East, Inc. 698 S Milledge Ave Athens, 30605 (800) 895-5577 Hanger Prosthetics & Orthotics, Inc. 1075 Prince Ave (706) 369-1071 Home Medical Professional 191 Alps Rd ste 8 (706) 433-0715 Lincare, Inc 2440 W Broad St Ste 9 (706) 549-8968 Hospice Heartland Hospice Services 330 Research Dr Suite 130 Athens, 30605 (706) 369-0917 MRI Open MRI of Athens 845 Prince Ave (706) 549-1118 Physical Therapy East Athens Physical Therapy 665 Gaines School Rd Athens, 30605 (706) 369-8115 Horizon Physical Therapy and Rehabilitation, Inc. 2319 Prince Ave (706) 548-7300 Physical, Speech, Occup Therapy Physiotherapy Associates 788 Prince Ave ste C (706) 355-3035 Prosthetics/Orthotics Apria Healthcare, Inc. 5095 Jefferson Rd Athens, 30607 (706) 546-4477 Atlanta Prosthetics & Orthotics, Inc. 1000 Hawthorne Ave Suite L (706) 425-1819 Hanger Prosthetics & Orthotics, Inc. 1075 Prince Ave (706) 369-1071 Radiology Athens Diagnostic Center 1063 Baxter St (706) 316-3662 Open MRI of Athens 845 Prince Ave (706) 549-1118 Rehabilitation Therapy Facility HealthSouth Sports Medicine & Rehab. Center 1000 Hawthorne Ave Ste J (706) 548-3438 Skilled Nursing Facility Guardian Home Care of Central Georgia, LLC 435 Hawthorne Ave (706) 354-6073 Speech/Hearing Therapy ABC Pediatric Therapy Partners, Inc 1175 Oglethorpe Ave (706) 353-2211 CLAYTON COUNTY, Ambulance Lifestar Response dba Care Ambulance 277 Southfield Pkwy Forest Park, 30297 (404) 629-1495 Ambulatory Surgery Center Akstein Eye Center 86 Upper Riverdale Rd (770) 996-4844 Atlanta South Endoscopy Center 34 Upper Riverdale Road Suite 201 (678) 904-9710 Clayton Cataract and Laser Surgery Center 1000 Corporate Center Dr Ste 180 Morrow, 30260 (770) 968-8888 G.I. Endoscopy Center 6555 Professional Pl (770) 996-8830 Southern Crescent Endoscopy Center 7402 Davidson Pkwy S (770) 507-0909 Surgery Center At Mt. Zion 4000 Corporate Center Dr Morrow, 30260 (770) 960-2701 Dialysis Renal Care Group Clayton County 335 Upper Riverdale Rd -1 Jonesboro, 30236 (770) 907-9001 Dialysis Center Forest Park Dialysis 380 Forest Pkwy Forest Park, 30297 (404) 361-0646 Jonesboro Dialysis 129 King St Jonesboro, 30236 (770) 471-2381 Renal Treatment Centers- Jonesboro Dialysis 129 King St Jonesboro, 30236 (770) 471-2381 Southern Crescent Dialysis Center 275 Upper Riverdale Rd SW (770) 907-7022 Durable Medical Equipment American Homecare Supply, Georgia, Inc 4820 Clark Howell Hwy -4 Atlanta, 30349 (404) 669-0577 Hanger Prosthetics & Orthotics, Inc. 155 Medical Way (770) 997-3674 SleepMed, Inc 217 Arrowhead Blvd 3 Jonesboro, 30236 (800) 846-2973 Home Health Agency Mobile Home Health Services, Inc 203 Medical Way (770) 909-4114 Hospice Embracing Hospice Care of South Atlanta LLC 315 Arrowhead Blvd Jonesboro, 30236 (678) 961-2610 In Home Health, Inc. 1335 Lake Ridge Pkwy Riverdale, 30296 (770) 994-6569 Laboratory Quest Diagnostics - Riverdale 107 Upper Riverdale Rd SW (770) 991-2030 Quest Diagnostics-Riverdale 83 Upper Riverdale Rd Ste 120 (770) 991-2030 Physical Therapy Children's Healthcare of Atlanta at Mt. Zion 2201 Mount Zion Pkwy Morrow, 30260 (404) 785-8841 Excel Physical therapy 1883 McDonough Rd Bldg 200 Hampton, 30228 (678) 432-4621 Physical, Speech, Occup Therapy Morrow Physical Therapy 3000 Corporate Center Dr Ste 255 Morrow, 30260 (770) 968-9206 Physiotherapy Associates 1669 Phoenix Pkwy Ste 102 Atlanta, 30349 (770) 907-1023 335 Upper Riverdale Rd 10 Jonesboro, 30236 (770) 907-5743 541 Forest Pky Ste 14 Forest Park, 30297 (404) 361-3605 Rehab South Physical Therapy-Southside 150 Medical Way Ste E1 (770) 991-2747 Prosthetics/Orthotics Hanger Prosthetics & Orthotics, Inc. 155 Medical Way (770) 997-3674 Radiology Am-Med Medical Imaging 34 Upper Riverdale Road Suite 102 (770) 991-6001 Children's Radiology of Atlanta 237 Medical Way (770) 442-2155 Open MRI Centers of Georgia 6584 Professional Pl Suite D (770) 991-6001 Radiology Associates of Clayton 33 Upper Riverdale Rd SW Ste 105 (770) 991-9729 Riverdale Radiology Center, LLC 237 Medical Way (770) 909-0488 South Atlanta Radiology Associates, P.C. 119 Upper Riverdale Rd SW (770) 991-1010 Rehabilitation Therapy Facility Concentra Health Services 1368 Southlake Plaza Dr Morrow, 30260 (678) 422-8824 4223 Moreland Ave Conley, 30288 (770) 242-7744 5044 Clark Howell Hwy Atlanta, 30349 (404) 765-2400 HealthSouth Sports Medicine & Rehab. Center 6319 A Jonesboro Rd Morrow, 30260 (770) 960-9575 HealthSouth Sports Medicine & Rehabilitation Ctr 275 Upper Riverdale Rd SW (770) 991-6755 Southern Regional Medical Center 11 Upper Riverdale Rd SW (770) 991-8000 Sleep Disorders Do You Snore, LLC 6555 Professional Pl (404) 892-0308 SleepMed, Inc 217 Arrowhead Blvd 3 Jonesboro, 30236 (800) 846-2973 The Sleep Disorders Centers of Southeastern Lung Care in South Atlanta 181 Upper Riverdale Rd SW Building A, Suite 2 (770) 994-3008 Speech/Hearing Therapy Children's Healthcare of Atlanta at Mt. Zion 2201 Mount Zion Pkwy Morrow, 30260 (404) 785-8841 COBB COUNTY, Ambulatory Surgery Center Ambulatory Foot & Leg Surgical Center 1652 Mulkey Rd (770) 941-3633 Cobb Endoscopy Center, LLC 3969 S Cobb Dr SE Suite 207 Smyrna, 30080 (770) 432-5326 Cobb Foot & Leg Surgical Center 792 Church St Suite 401 (770) 422-9256 East West Surgery Center, LP 2041 Mesa Valley Way Ste 125 (678) 309-8100 A member may seek services at any Ancillary Provider listed above under the direction of their Primary Care Physician(PCP) as required by their benefit plan. If PCP direction is required and the member seeks care without contacting their PCP, services may be denied. Please consult your Certificate of Coverage for full benefit information. Please visit us on the 13

Ancillary Providers Cobb Ambulatory Surgery Center GI Diagnostics Endoscopy Center, LLC 2550 Windy Hill Rd SE Ste 302 Marietta, 30067 (770) 226-9070 Marietta Eye Clinic DBA Marietta Eye Surgery 895 Canton Rd Bldg 200 Suite 300 (678) 784-0203 Marietta Surgical Center 780 Canton Rd (770) 422-1579 Northwest Georgia Orthopeadic Surgery Center 2550 Windy Hill Rd SE Ste 218 Marietta, 30067 (770) 953-8058 The Center for Spine Procedures, PC 335 Roselane St NW (770) 420-1420 Urology Associates Surgery Center, LLC 300 Tower Rd Suite 150 (678) 594-0070 Wellstar Kennestone Surgery Center-Outpatient 677 Church St (770) 793-5740 Westside Endoscopy Center 3825 Medical Park Dr (770) 941-4810 Audiology Children's Healthcare of Atlanta in Cobb 1371 Church Street Ext (770) 425-0752 Progressive Audiology Center, Inc 3960 Shallowford Rd Marietta, 30062 (770) 993-1728 Diagnostic Facility A Diagnostic Radiology Network Facility 2501 Chastain Meadows Pkwy Marietta, 30066 (800) 953-5510 Atlantic Diagnostic Center, LLC 1620 Mulkey Rd (770) 794-5000 Cardiac CT Imaging Center at 55 Witcher Street 55 Whitcher St Suite 150 (678) 337-7000 Dialysis Center Bio-Medical Applications of South Cobb 3565 Austell Rd SW Ste 13 Marietta, 30008 (770) 432-0066 Cobb Nephrology Dialysis Center, Inc. 3865 Medical Park Dr (770) 732-8616 Fresenius Medical Care of North Cobb 1392 Bells Ferry Rd Marietta, 30066 (770) 528-3898 RCC Marietta 1277 Kennestone Cir Ste 600 Marietta, 30066 (770) 424-8391 Renal Care Group Smyrna 2700 Highlands Pkwy SE Smyrna, 30082 (678) 303-5064 Durable Medical Equipment Access Homecare Services, Inc 2211 New Market Pkwy SE Ste 156 Marietta, 30067 (678) 391-6900 Advanced Home Medical 1395 S Marietta Pkwy SE Bldg 100, Ste 106 Marietta, 30067 (770) 426-4310 American Homecare Supply, Georgia, Inc 2010 Cobb International Blvd NW Ste D Kennesaw, 30152 (770) 499-7717 Apria Healthcare, Inc. 2211 New Market Pkwy SE Ste 156 Marietta, 30067 (770) 818-1471 Byram Healthcare 220 Cobb Pkwy N Marietta, 30062 (877) 902-9726 C.H. Martin 472 N Sessions St NW (770) 499-1940 DJO, LLC 707 WHITLOCK AVE STE F3 Marietta, 30069 (800) 321-9549 Dynamic Orthotics & Prosthetics, Inc. 1900 The Exchange SE Suite 375 Atlanta, 30339 (770) 953-4877 Hanger Prosthetics & Orthotics, Inc. 124 Powers Ferry Rd SE Marietta, 30067 (770) 977-5462 Healthfield Inc 1395 S Marietta Pkwy SE Ste 910 Marietta, 30067 (770) 951-6100 Hi-Tech Healthcare, Inc 718 Cherokee St (770) 792-0030 Lincare, Inc 4451 Atlanta Rd SE Ste 106 Smyrna, 30080 (770) 435-0000 Pediatric Services of America, Inc 2217 Roswell Rd 100 Marietta, 30062 (770) 321-6600 Physiotherapy 4579 S Cobb Dr SE ste 100 Smyrna, 30080 (770) 436-3665 Source One Medical, Inc 2121 New Market Pkwy SE Suite 108 Marietta, 30067 (770) 818-0060 Vision Quest Industries, Inc. 4902 Lake Acworth Dr Acworth, 30101 (800) 266-2929 Wellstar Home Medical Equipment 805 Sandy Plains Rd Marietta, 30066 (770) 792-1625 Home Health Agency Coram Alternate Site Services, Inc. 2140 New Market Pkwy SE Suite 106 Marietta, 30067 (770) 952-3021 Healthfield Home Health Inc 1395 S Marietta Pkwy SE Ste 910 Marietta, 30067 (770) 951-6100 Matria Healthcare, Inc 1850 Parkway Pl SE Marietta, 30067 (770) 767-4600 Pediatric Services of America, Inc 2217 Roswell Rd 100 Marietta, 30062 (770) 321-6600 The Healthfield Group, Inc. 3350 Riverwood Pkwy SE Suite 1400 Atlanta, 30339 (770) 951-6100 Wellstar Home Health 805 Sandy Plains Rd Marietta, 30066 (770) 792-1616 Wellstar Private Homecare Services 805 Sandy Plains Rd Marietta, 30066 (770) 792-1620 Home IV Infusion Agency Lacey's Vital Care 790 Church St ste 170 (770) 424-3131 Pediatric Services of America, Inc 2217 Roswell Rd 100 Marietta, 30062 (770) 321-6600 Premier Healthcare Solutions, LLC 4451 Atlanta Rd SE Ste 136 Smyrna, 30080 (770) 803-1007 Hospice Healthfield Hospice Services Inc 1395 S Marietta Pkwy SE Ste 902 Marietta, 30067 (770) 951-6251 Heritage Hospice, Inc. 1290 Kennestone Cir 213 Marietta, 30066 (770) 423-5959 Wellstar Community Hospice 4040 Hospital West Dr (770) 732-6710 Laboratory Quest Diagnostics - Marietta 790 Church Street Ext (770) 424-2622 MRI MRI & Imaging of Marietta 300 Tower Rd (770) 933-1963 Occupational Therapy East Cobb Shoulder, Elbow, Hand Therapy 3901 Roswell Rd -B Marietta, 30062 (770) 578-4334 Venture Hand Therapy 5041 Dallas Hwy Powder Springs, 30127 (770) 423-3500 Physical Therapy Benchmark Physical therapy 1025 E West Connector ste 4 (770) 384-1001 BenchMark Physical Therapy - Kennestone 400 Tower Rd Suite 140 (770) 419-9437 Children's Healthcare of Atlanta at Town Center 2985 George Busbee Pkwy NW Kennesaw, 30144 (404) 785-6880 Remobility, Inc 3901 Roswell Rd -A Marietta, 30062 (770) 578-4343 Venture Hand Therapy 5041 Dallas Hwy Powder Springs, 30127 (770) 423-3500 Physical, Speech, Occup Therapy Axiom Physical Therapy 736 Johnson Ferry Rd -12 Marietta, 30068 (770) 321-4720 BenchMark Physical Therapy 2550 Windy Hill Rd SE Ste 208 Marietta, 30067 (770) 916-1567 Building Blocks Pediatric Therapy, Inc. 1240 Johnson Ferry Rd -50 Marietta, 30068 (404) 202-5038 Georgia Physical Therapy, LLC (NovaCare) 1121 Johnson Ferry Rd Ste 210 Marietta, 30068 (770) 977-8111 114 Cherry St Ste 1 (770) 424-2898 211 Chicopee Dr (770) 422-0084 440 Red Bud Rd, Sequoia Shopping Center (706) 629-0622 652 Church St (770) 427-8885 OrthoSport Physical Therapy, LLC 3450 Acworth Due West Rd NW Ste 310 Kennesaw, 30144 (770) 974-7494 3855 Shallowford Rd Ste 415 Marietta, 30062 (770) 420-1122 Physiotherapy Associates 1431 White Cir Marietta, 30066 (770) 426-9945 1995 N Park Pl SE Ste 230 Atlanta, 30339 (770) 850-0390 2155 Post Oak Tritt Rd Ste 400 Marietta, 30062 (770) 565-4044 2550 Windy Hill Rd SE Ste 208 Marietta, 30067 (770) 850-0390 3330 S Cobb Dr SE Smyrna, 30080 (770) 436-3665 833 Campbell Hill St NW Ste 460 (770) 426-9945 Physiotherapy Assoicates 3105 Creekside Village Dr NW Ste 01 Kennesaw, 30144 (678) 574-6868 Remobility, Inc 4131 Christacy Way Marietta, 30066 (770) 620-1779 Wellstar Cobb Hospital- Outpatient Rehabilitation 3950 Austell Rd (770) 732-4100 Wellstar Kennestone Hospital-Outpatient Rehabilitation 100 Lacy St NW (770) 793-7600 Wellstar Windy Hill Hospital- Outpatient Rehabiliation 2540 Windy Hill Rd SE Marietta, 30067 (770) 644-1550 Prosthetics/Orthotics Apria Healthcare, Inc. 2211 New Market Pkwy SE Ste 156 Marietta, 30067 (770) 818-1471 Children's Healthcare of Atlanta in Cobb 1371 Church Street Ext (770) 425-0752 DJO, LLC 707 WHITLOCK AVE STE F3 Marietta, 30069 (800) 321-9549 Hanger Prosthetics & Orthotics, Inc. 124 Powers Ferry Rd SE Marietta, 30067 (770) 977-5462 Radiology East Cobb MRI Center LLC 1197 Johnson Ferry Rd Marietta, 30068 (770) 971-7284 A member may seek services at any Ancillary Provider listed above under the direction of their Primary Care Physician(PCP) as required by their benefit plan. If PCP direction is required and the member seeks care without contacting their PCP, services may be denied. Please consult your Certificate of Coverage for full benefit information. Please visit us on the 14