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General NPI Number Information
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NPI Number | 1104231232
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Entity Type | Individual
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Provider Name | JASON CUOMO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 3970 GRANDVIEW DR STE 2300
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-3163
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Country | US
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Telephone | 864-235-7665
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Fax | 864-233-5971
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Provider Business Mailing Address
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Address Line | 1120 15TH ST
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-2423
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Fax | 706-721-6918
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 93138
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 6780
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License Number State | GA
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