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General NPI Number Information
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NPI Number | 1104155712
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Entity Type | Organization
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Legal Business Name | NEW VISION CARE INC
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 2450 GALLERIA PKWY SE
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City | ATLANTA
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State | GA
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Zip | 30339-3130
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Country | US
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Telephone | 404-314-9899
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 105603 #51164
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City | ATLANTA
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State | GA
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Zip | 30348-5603
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Country | US
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Telephone | 404-314-9899
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DOUGLAS CALDWELL COLLINS
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Credential | M.D.
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Telephone | 404-314-9899
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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 | 020092
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License Number State | GA
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