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General NPI Number Information
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NPI Number | 1073270997
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Entity Type | Organization
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Legal Business Name | AMBROSIA FUNCTIONAL MEDICINE LLC
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Dates
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Enumeration Date | 11/27/2021
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1668 MULKEY RD STE G
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City | AUSTELL
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State | GA
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Zip | 30106-1163
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Country | US
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Telephone | 404-585-4964
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Fax | 404-581-5838
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Provider Business Mailing Address
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Address Line | 5878 GRAYWOOD CIR SE
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City | MABLETON
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State | GA
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Zip | 30126-2894
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Country | US
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Telephone | 404-585-4964
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Fax | 404-581-5838
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. CHIBUZOR STEVE EKE
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Credential | FNP-C
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Telephone | 404-585-4964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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