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General NPI Number Information
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NPI Number | 1396743514
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Entity Type | Organization
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Legal Business Name | RENAISSANCE SURGICAL CENTRE, LLC
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4030 RIVERSIDE PARK BLVD
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City | MACON
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State | GA
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Zip | 31210-1365
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Country | US
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Telephone | 478-474-2200
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Fax | 478-314-0740
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Provider Business Mailing Address
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Address Line | 4030 RIVERSIDE PARK BLVD
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City | MACON
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State | GA
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Zip | 31210-1365
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Country | US
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Telephone | 478-474-2200
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Fax | 478-314-0740
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ROY POWELL
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Credential | MD
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Telephone | 478-474-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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