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General NPI Number Information
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NPI Number | 1023863669
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Entity Type | Individual
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Provider Name | SHAQUITA JAMISON MA
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Gender | Female
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 523 VILLA ROSA RD
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City | TEMPLE
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State | GA
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Zip | 30179-4253
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Country | US
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Telephone | 404-573-3654
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 S PARK ST # 1030
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City | CARROLLTON
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State | GA
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Zip | 30117-4433
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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