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General NPI Number Information
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NPI Number | 1417187022
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Entity Type | Individual
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Provider Name | SCOTT JOSEPH WAGUESPACK MD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 5960 OGEECHEE RD STE C
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City | SAVANNAH
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State | GA
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Zip | 31419-7506
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Country | US
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Telephone | 912-349-2676
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Fax |
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Provider Business Mailing Address
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Address Line | 205 REES ST
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City | AMERICUS
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State | GA
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Zip | 31709-3756
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Country | US
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Telephone | 229-928-4755
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Fax | 229-928-4750
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 063014
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License Number State | GA
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