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General NPI Number Information
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NPI Number | 1215913512
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Entity Type | Individual
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Provider Name | RAQUEL M DECAMP PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 1700 HOSPITAL SOUTH DR SUITE 302
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City | AUSTELL
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State | GA
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Zip | 30106-6810
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Country | US
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Telephone | 770-739-0999
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Fax | 678-324-4275
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Provider Business Mailing Address
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Address Line | 1838 AMERICAN WAY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-6611
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Country | US
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Telephone | 770-995-7622
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Fax | 770-995-7854
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 004821
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License Number State | GA
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