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General NPI Number Information
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NPI Number | 1235118043
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Entity Type | Organization
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Legal Business Name | AUGUSTA RETINA LASER SURGICARE
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 3685 WHEELER RD SUITE 202
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City | AUGUSTA
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State | GA
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Zip | 30909-6446
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Country | US
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Telephone | 706-210-0305
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Fax | 706-210-0306
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Provider Business Mailing Address
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Address Line | PO BOX 11407
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City | BIRMINGHAM
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State | AL
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Zip | 35246-3035
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Country | US
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Telephone | 706-210-0305
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Fax | 706-210-0306
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Authorized Official
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Title or Position | CFO
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Name | MR. KEVIN BECKER
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Credential |
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Telephone | 706-243-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | GA
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