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General NPI Number Information
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NPI Number | 1306820279
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Entity Type | Individual
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Provider Name | DEBRA-ANN MAURITA CLARKE M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 01/16/2011
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Provider Practice Location Address
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Address Line | 1061 HARMON AVE SUITE 1D03
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City | FORT STEWART
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State | GA
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Zip | 31314-5641
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Country | US
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Telephone | 912-767-4549
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Fax | 912-767-4664
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Provider Business Mailing Address
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Address Line | 1061 HARMON AVE SUITE 1D03
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City | FORT STEWART
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State | GA
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Zip | 31314-5641
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Country | US
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Telephone | 912-767-4549
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Fax | 912-767-4664
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101237025
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License Number State | VA
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