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General NPI Number Information
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NPI Number | 1174960959
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Entity Type | Organization
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Legal Business Name | WOUND CARE SPECIALISTS, LLC
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 2304 SHORTER AVE NW
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City | ROME
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State | GA
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Zip | 30165-1944
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Country | US
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Telephone | 706-234-0899
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Fax | 877-840-9510
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Provider Business Mailing Address
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Address Line | 4686 RALEY RD
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City | MACON
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State | GA
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Zip | 31206-5332
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Country | US
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Telephone | 478-254-5943
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Fax | 478-254-6093
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Authorized Official
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Title or Position | OWNER
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Name | EDGAR L RHODES
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Credential | MD
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Telephone | 706-234-0899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12085
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License Number State | GA
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