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General NPI Number Information
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NPI Number | 1033359195
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Entity Type | Organization
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Legal Business Name | UHS OF SUMMITRIDGE, LLC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 250 SCENIC HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-5675
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Country | US
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Telephone | 678-442-5900
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Fax | 678-442-5909
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Provider Business Mailing Address
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Address Line | 250 SCENIC HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-5675
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Country | US
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Telephone | 678-442-5900
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Fax | 678-442-5909
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Authorized Official
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Title or Position | CFO
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Name | DELIA GONZALEZ
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Credential |
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Telephone | 678-442-5942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 067648
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License Number State | GA
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