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General NPI Number Information
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NPI Number | 1255976007
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Entity Type | Organization
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Legal Business Name | ANGIESANGELS LLC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 212 POLO LN
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3693
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Country | US
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Telephone | 770-334-7199
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41
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City | LOCUST GROVE
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State | GA
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Zip | 30248-0041
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Country | US
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Telephone | 678-759-9104
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLAUDETTE SIMON
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Credential | RN
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Telephone | 678-759-9104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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