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General NPI Number Information
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NPI Number | 1083111413
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Entity Type | Individual
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Provider Name | CONRAD WILLIAM SHEBELUT MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 2580 WESTSIDE PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30004-7426
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Country | US
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Telephone | 678-248-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 CRESCENT WALK
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City | DECATUR
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State | GA
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Zip | 30033-2402
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Country | US
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Telephone | 559-269-0183
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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 | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | 91228
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License Number State | GA
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