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General NPI Number Information
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NPI Number | 1225454648
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE CENTER OF GEORGIA, INC
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 870 COLLINS HILL RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4407
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Country | US
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Telephone | 678-377-0900
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Fax | 678-377-6556
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Provider Business Mailing Address
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Address Line | 870 COLLINS HILL RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4407
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Country | US
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Telephone | 678-377-0900
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Fax | 678-377-6556
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Authorized Official
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Title or Position | OWNER
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Name | DR. RIAZ A SYED
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Credential | MD
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Telephone | 678-377-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 043791
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License Number State | GA
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