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General NPI Number Information
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NPI Number | 1174811996
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE HEALTH CENTER LLC
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Dates
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Enumeration Date | 07/13/2011
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 2000 RIVERSIDE PKWY SUITE 206
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5926
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Country | US
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Telephone | 678-407-8230
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Fax | 678-407-8233
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Provider Business Mailing Address
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Address Line | 2000 RIVERSIDE PKWY SUITE 206
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5926
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Country | US
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Telephone | 678-407-8230
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Fax | 678-407-8233
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. RAYMOND T ALEXANDER
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Credential | DC
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Telephone | 678-407-8230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR002925
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN198365
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 53982
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License Number State | GA
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