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General NPI Number Information
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NPI Number | 1104039486
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Entity Type | Organization
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Legal Business Name | USMAMMO
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1175 PEACHTREE ST NE SUITE 1425
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City | ATLANTA
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State | GA
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Zip | 30361-6202
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Country | US
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Telephone | 404-419-6644
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Fax | 678-904-2591
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Provider Business Mailing Address
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Address Line | 1175 PEACHTREE ST NE SUITE 1425
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City | ATLANTA
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State | GA
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Zip | 30361-6202
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Country | US
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Telephone | 404-419-6644
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Fax | 678-904-2591
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Authorized Official
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Title or Position | CEO,PRESIDENT
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Name | DR. MARTHA D GARRISON
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Credential | M.D.
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Telephone | 404-419-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 0609796
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License Number State | GA
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