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General NPI Number Information
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NPI Number | 1003200015
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Entity Type | Organization
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Legal Business Name | MID GEORGIA TOTAL CARE LLC
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1111 GRIFFIN AVE STE 1B
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City | EASTMAN
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State | GA
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Zip | 31023-9104
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Country | US
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Telephone | 478-374-8998
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Fax | 478-374-8525
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Provider Business Mailing Address
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Address Line | 1111 GRIFFIN AVE STE 1B
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City | EASTMAN
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State | GA
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Zip | 31023-9104
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Country | US
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Telephone | 478-374-8998
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Fax | 478-374-8525
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Authorized Official
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Title or Position | CEO
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Name | KEVIN BIERSCHENK
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Credential |
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Telephone | 478-344-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | GA
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