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General NPI Number Information
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NPI Number | 1285393439
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Entity Type | Organization
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Legal Business Name | BELLA MONIQUE LLC
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 1445 WOODMONT LN NW # 1205
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 912-288-5907
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Fax | 912-452-1130
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Provider Business Mailing Address
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Address Line | PO BOX 1174
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City | BLACKSHEAR
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State | GA
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Zip | 31516-3674
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Country | US
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Telephone | 912-288-5907
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHAVONNE BELLAMY
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Credential |
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Telephone | 912-722-3281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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