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General NPI Number Information
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NPI Number | 1407844624
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE SMITH M.D
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Gender | Female
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 402 N 4TH AVE SW
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City | ROME
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State | GA
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Zip | 30165-2812
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Country | US
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Telephone | 706-292-3045
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Fax | 706-292-3044
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Provider Business Mailing Address
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Address Line | 11347 BIG BEND RD
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City | RIVERVIEW
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State | FL
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Zip | 33579-7183
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Country | US
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Telephone | 813-418-7282
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Fax | 813-677-7141
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME61157
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License Number State | FL
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