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General NPI Number Information
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NPI Number | 1053011452
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Entity Type | Organization
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Legal Business Name | ALIVE HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 377 W PIKE ST STE A3
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3206
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Country | US
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Telephone | 470-523-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 377 W PIKE ST STE A3
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3206
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Country | US
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Telephone | 470-523-5570
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | ESTHER SWEETHEART GENSINGER
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Credential | FNP
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Telephone | 470-523-5570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0001X
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Taxonomy Name | Clinical & Laboratory Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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