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General NPI Number Information
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NPI Number | 1427086909
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Entity Type | Individual
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Provider Name | TRICIA-MAY VILLANUEVA HARRIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 3651 WHEELER ROAD
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-651-2369
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Fax | 706-651-2364
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Provider Business Mailing Address
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Address Line | 1335 QUEENS FERRY RD
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City | FLORENCE
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State | SC
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Zip | 29505-3790
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Country | US
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Telephone | 843-665-9958
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 052313
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License Number State | GA
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