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General NPI Number Information
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NPI Number | 1285633842
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Entity Type | Individual
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Provider Name | JOHN PENUEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 821 N COBB ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-2343
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Country | US
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Telephone | 478-452-0524
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Fax | 478-452-0525
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Provider Business Mailing Address
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Address Line | 1854 SHACKLEFORD CT SUITE 350
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City | NORCROSS
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State | GA
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Zip | 30093-2954
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Country | US
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Telephone | 770-688-3801
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Fax | 770-237-6148
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 9900983
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 048926
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License Number State | GA
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