Practice Name | Medical Specialty in City or Region

3330 Cumberland Blvd., Suite 200
Atlanta, GA 30339
Phone: 770-951-8427
Fax: 770-951-2157

Bill Payment

Practice Name makes it easy for our patients to pay for their medical care by offering secure, online bill payment. Simply click on the "Pay My Bill" button below to start the process.

You will be directed to our secure payment portal. Please use the account number on your most recent bill. If you have any questions, please contact our office.

Credit Cards Accepted

  • Practice Name Accepts Visa
  • Practice Name Accepts MasterCard
  • Practice Name Accepts American Express
  • Practice Name Accepts Discover
Patient Account Information
Patient Name:
Patient Account:
Date of Birth:
Telephone Number:
Email Address:
Comments:
Credit Card Information
First Name:
Last Name:
Street Address:
City:
State:
Zip Code:
Credit Card Type:
Credit Card Number:
Expiration Date: /
Credit Card CCV: (3 or 4 digit security code)
Payment Amount: