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General NPI Number Information
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NPI Number | 1164487823
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Entity Type | Organization
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Legal Business Name | IMMANUEL FAMILY PRACTICE
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 5500 W FRIENDLY AVE SUITE 201
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City | GREENSBORO
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State | NC
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Zip | 27410-4212
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Country | US
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Telephone | 336-856-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 W FRIENDLY AVE SUITE 201
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City | GREENSBORO
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State | NC
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Zip | 27410-4212
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Country | US
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Telephone | 336-856-9996
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BETTI D REESE
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Credential | MD
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Telephone | 336-856-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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