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General NPI Number Information
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NPI Number | 1104852078
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Entity Type | Individual
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Provider Name | MICHELLE LEE DUPONT PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 101 YORKTOWN DR STE 203
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1578
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Country | US
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Telephone | 770-474-7416
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Fax | 706-920-7617
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Provider Business Mailing Address
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Address Line | 101 SPRINGRIDGE CT
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1143
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Country | US
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Telephone | 770-474-7416
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Fax | 770-692-0761
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003062
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License Number State | GA
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