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General NPI Number Information
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NPI Number | 1194235853
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Entity Type | Organization
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Legal Business Name | COVENANT MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 3605 SANDY PLAINS RD STE 240-235
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City | MARIETTA
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State | GA
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Zip | 30066-3068
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Country | US
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Telephone | 770-990-8212
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Fax |
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Provider Business Mailing Address
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Address Line | 2330 TALL TIMBERS LN
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City | MARIETTA
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State | GA
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Zip | 30066-2117
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Country | US
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Telephone | 770-990-8212
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NGOZIKA ORJIOKE
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Credential | MD
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Telephone | 770-990-8212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 65598
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License Number State | GA
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