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General NPI Number Information
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NPI Number | 1326001686
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Entity Type | Individual
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Provider Name | BUFORD OTTO EDWARDS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/08/2006
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 760 26TH AVE SE
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City | MOULTRIE
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State | GA
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Zip | 31768-6799
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Country | US
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Telephone | 229-985-1457
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Fax | 229-890-9430
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Provider Business Mailing Address
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Address Line | 2410 HOG MOUNTAIN RD ST 307
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City | WATKINSVILLE
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State | GA
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Zip | 30677-4811
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Country | US
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Telephone | 706-769-7911
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Fax | 706-769-0826
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 028160
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License Number State | GA
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