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General NPI Number Information
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NPI Number | 1194372995
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH HOSPICE LLC
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 2302 PARKLAKE DR NE STE 143
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City | ATLANTA
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State | GA
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Zip | 30345-2896
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Country | US
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Telephone | 470-395-1000
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Fax | 470-395-1001
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Provider Business Mailing Address
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Address Line | 6600 SUGARLOAF PKWY STE 400-204
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City | DULUTH
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State | GA
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Zip | 30097-4344
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Country | US
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Telephone | 404-314-8345
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Fax | 470-385-6805
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIMBERLY PARKER
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Credential |
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Telephone | 470-395-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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