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General NPI Number Information
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NPI Number | 1104294461
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Entity Type | Organization
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Legal Business Name | ATLANTA CENTER FOR INTEGRATIVE MED
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 2751 BUFORD HWY NE SUITE 700
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City | ATLANTA
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State | GA
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Zip | 30324-3207
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Country | US
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Telephone | 404-386-6510
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Fax | 702-975-5031
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Provider Business Mailing Address
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Address Line | 2751 BUFORD HWY SUITE 700
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City | ATLANTA
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State | GA
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Zip | 30324
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Country | US
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Telephone | 404-386-6510
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Fax | 702-975-5031
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Authorized Official
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Title or Position | MD, FAAP
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Name | MICHELE SEWELL
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Credential |
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Telephone | 404-386-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 036281
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License Number State | GA
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