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General NPI Number Information
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NPI Number | 1326064395
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Entity Type | Individual
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Provider Name | CARISA LYNETTE HINES MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 315 BOULEVARD NE SUITE 242
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City | ATLANTA
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State | GA
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Zip | 30312-1200
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Country | US
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Telephone | 404-588-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 6915 KIMBERLY MILL RD
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City | COLLEGE PARK
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State | GA
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Zip | 30349-4723
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Country | US
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Telephone | 770-909-5061
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Fax |
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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 | 40808
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2018-0302
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 050637
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD.32903
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License Number State | AL
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