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General NPI Number Information
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NPI Number | 1386433258
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Entity Type | Organization
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Legal Business Name | ONE SOURCE VASCULAR
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2003B ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-6209
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Country | US
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Telephone | 912-490-9420
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Fax | 912-514-9180
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Provider Business Mailing Address
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Address Line | 501 W ONEIDA ST
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City | WAYCROSS
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State | GA
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Zip | 31501-5337
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Country | US
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Telephone | 912-283-7596
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Fax | 912-283-1618
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DAVID P MURPHY
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Credential | DPM
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Telephone | 912-283-6471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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