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General NPI Number Information
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NPI Number | 1174382964
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST VISION CARE GEORGIA PLLC
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 239 MARKET PLACE BLVD
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City | CARTERSVILLE
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State | GA
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Zip | 30121-2235
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Country | US
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Telephone | 770-607-1448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 631665
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City | CINCINNATI
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State | OH
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Zip | 45263-1665
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Country | US
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Telephone | 817-757-3225
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLE MANAGEMEN
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Name | KRYSTAL VAN DRESAR
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Credential |
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Telephone | 817-757-3225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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