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General NPI Number Information
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NPI Number | 1083424857
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Entity Type | Organization
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Legal Business Name | GALE PRIMARY CARE, LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 3702 JEFFERSON AVE
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City | MOSS POINT
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State | MS
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Zip | 39563-6218
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Country | US
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Telephone | 228-641-1674
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Fax | 228-205-4593
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Provider Business Mailing Address
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Address Line | 3702 JEFFERSON AVE
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City | MOSS POINT
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State | MS
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Zip | 39563-6218
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Country | US
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Telephone | 228-641-1674
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Fax | 228-205-4593
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Authorized Official
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Title or Position | OWNER
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Name | TAMMY GALE
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Credential | FNP-BC
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Telephone | 228-641-1674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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