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General NPI Number Information
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NPI Number | 1326366154
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Entity Type | Organization
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Legal Business Name | RADIANT FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 1 TECHNOLOGY PKWY S
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City | NORCROSS
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State | GA
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Zip | 30092-2928
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Country | US
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Telephone | 678-713-2600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 671047
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City | MARIETTA
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State | GA
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Zip | 30066-0135
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Country | US
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Telephone | 404-635-6117
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HINA HUSSAIN
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Credential | M.D.
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Telephone | 404-635-6117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 055063
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License Number State | GA
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