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General NPI Number Information
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NPI Number | 1194898940
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Entity Type | Individual
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Provider Name | AMIE ALAGOOD LOCICERO P.T.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 545 OLD NORCROSS RD SUITE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3389
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Country | US
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Telephone | 678-377-2833
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Fax | 678-377-2882
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Provider Business Mailing Address
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Address Line | 4727 ARDMORE LN
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City | HOSCHTON
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State | GA
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Zip | 30548-6228
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Country | US
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Telephone | 770-307-5909
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Fax | 678-377-2882
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 004192
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License Number State | GA
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