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General NPI Number Information
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NPI Number | 1194704148
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Entity Type | Individual
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Provider Name | MAI LI DONG MD
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Gender | Female
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 1000 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7694
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Country | US
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Telephone | 770-963-9905
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Fax | 770-962-9814
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Provider Business Mailing Address
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Address Line | 1000 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7694
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Country | US
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Telephone | 770-963-9905
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Fax | 770-962-9814
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 027361
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 045770
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License Number State | GA
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