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General NPI Number Information
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NPI Number | 1366745549
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Entity Type | Organization
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Legal Business Name | EJ SNYDER MEDICAL, LLC
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Dates
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Enumeration Date | 12/10/2010
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Last Update Date | 12/10/2010
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Provider Practice Location Address
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Address Line | 525 WESTPARK DR SUITE 100
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1575
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Country | US
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Telephone | 770-487-0029
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Fax | 770-692-0116
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Provider Business Mailing Address
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Address Line | 525 WESTPARK DR SUITE 100
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1575
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Country | US
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Telephone | 770-487-0029
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Fax | 770-692-0116
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Authorized Official
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Title or Position | OWNER
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Name | DR. EARL JAY SNYDER
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Credential | MD
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Telephone | 770-487-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 55703
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License Number State | GA
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