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General NPI Number Information
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NPI Number | 1346572898
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Entity Type | Organization
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Legal Business Name | SYLVANIA CARE CENTER INC
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Dates
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Enumeration Date | 02/09/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 2897 N DRUID HILLS RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-3924
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Country | US
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Telephone | 404-502-2478
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 S VOSS RD # 110-135
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City | HOUSTON
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State | TX
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Zip | 77057-1086
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Country | US
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Telephone | 404-502-2478
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PORTIA SMITH
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Credential |
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Telephone | 40450224782
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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 |
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License Number State |
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