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General NPI Number Information
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NPI Number | 1205285475
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Entity Type | Individual
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Provider Name | CHRISTOPHER GOLDEN QASP
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Gender | Male
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 10175 FORTUNE PKWY SUITE 903
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6746
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Country | US
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Telephone | 904-538-0713
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Fax | 904-538-0714
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Provider Business Mailing Address
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Address Line | 19707 HWY 280 E APT 309
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City | SMITHS STATION
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State | AL
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Zip | 36877-4031
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Country | US
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Telephone | 256-566-7892
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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