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General NPI Number Information
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NPI Number | 1356710461
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Entity Type | Organization
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Legal Business Name | SALUS VIRTUAL CARE CLINIC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 914 MEMORIAL DR
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City | WAYCROSS
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State | GA
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Zip | 31501-2917
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Country | US
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Telephone | 912-285-0902
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Fax | 912-285-0904
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Provider Business Mailing Address
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Address Line | PO BOX 285
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City | WAYCROSS
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State | GA
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Zip | 31502-0285
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Country | US
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Telephone | 912-285-0902
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Fax | 912-285-0904
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Authorized Official
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Title or Position | CEO
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Name | PAULA B GUY
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Credential |
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Telephone | 912-285-0902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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