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General NPI Number Information
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NPI Number | 1316920952
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Entity Type | Individual
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Provider Name | ALFONSO MARTINEZ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 6000 SHAKERAG HL SUITE 216
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-6523
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Country | US
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Telephone | 770-632-1088
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Fax | 770-632-2088
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Provider Business Mailing Address
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Address Line | 406 MOUNT VERNON TRCE
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2641
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Country | US
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Telephone | 770-629-4575
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Fax | 770-629-4575
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY5814
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY3117
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License Number State | GA
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