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General NPI Number Information
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NPI Number | 1386984649
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Entity Type | Organization
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Legal Business Name | MIDWAY MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 27550 STATE HIGHWAY 75 STE 105
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City | ONEONTA
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State | AL
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Zip | 35121-3204
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Country | US
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Telephone | 256-451-1250
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 568
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City | ONEONTA
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State | AL
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Zip | 35121-0007
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Country | US
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Telephone | 256-451-1250
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MUHAMMAD EJAZ ATA
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Credential | MD
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Telephone | 256-599-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | AL
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