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General NPI Number Information
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NPI Number | 1023945599
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Entity Type | Individual
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Provider Name | MADISON MORO
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Gender | Female
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 615 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2504
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Country | US
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Telephone | 423-425-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 7172 BRAVEHEART LN
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City | OOLTEWAH
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State | TN
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Zip | 37363-7132
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Country | US
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Telephone | 423-599-4879
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 262411
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License Number State | TN
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