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General NPI Number Information
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NPI Number | 1154558468
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Entity Type | Individual
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Provider Name | HAILEY A AMICK M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 1534 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-4005
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Country | US
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Telephone | 404-778-3903
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Fax |
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Provider Business Mailing Address
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Address Line | 408 DREXEL AVE
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City | DECATUR
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State | GA
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Zip | 30030-2808
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Country | US
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Telephone | 864-905-0187
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 49899
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License Number State | TN
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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 | LL31786
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License Number State | SC
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