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General NPI Number Information
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NPI Number | 1255062832
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Entity Type | Organization
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Legal Business Name | LONGLEAF PRIMARY CARE, LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 171 TOWN CENTER DR
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City | ANNISTON
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State | AL
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Zip | 36205-4102
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Country | US
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Telephone | 256-237-1624
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5430
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City | ANNISTON
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State | AL
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Zip | 36205-0430
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Country | US
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Telephone | 256-237-1624
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Fax | 256-241-2277
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. RENEE DAVIS
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Credential |
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Telephone | 256-237-1624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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