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General NPI Number Information
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NPI Number | 1255483756
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Entity Type | Individual
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Provider Name | PAUL LOUIS DESANDRE DO
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Gender | Male
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-321-6111
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Fax | 404-417-1510
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Provider Business Mailing Address
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Address Line | 1670 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-251-8921
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Fax | 404-688-6351
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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 | 207PH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
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License Number | 64528
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 64528
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License Number State | GA
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