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General NPI Number Information
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NPI Number | 1033184767
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Entity Type | Individual
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Provider Name | J. MARK RHEUDASIL MD
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 5673 PEACHTREE DUNWOODY RD NE SUITE 675
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City | ATLANTA
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State | GA
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Zip | 30342-1731
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Country | US
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Telephone | 678-843-5400
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Fax | 678-843-5449
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Provider Business Mailing Address
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Address Line | 1838 AMERICAN WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6611
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Country | US
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Telephone | 770-995-7622
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Fax | 770-995-7854
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 026926
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 026926
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License Number State | GA
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