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General NPI Number Information
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NPI Number | 1093332785
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Entity Type | Organization
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Legal Business Name | DEDICATED CARE PARTNERS OF GEORGIA
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 965 MAIN ST STE B
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-2984
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Country | US
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Telephone | 770-322-4906
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Fax |
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Provider Business Mailing Address
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Address Line | 6937 WHISPERING WIND WAY
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-4532
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Country | US
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Telephone | 678-478-3726
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | CARNEISHA WATERS
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Credential |
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Telephone | 678-478-3726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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