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General NPI Number Information
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NPI Number | 1427150689
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Entity Type | Individual
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Provider Name | GARY T SMITH PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1109 EAGLES LANDING PKWY
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6394
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Country | US
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Telephone | 770-389-9004
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Fax |
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Provider Business Mailing Address
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Address Line | 412 MAZLEY DR
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City | LOCUST GROVE
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State | GA
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Zip | 30248-7027
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Country | US
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Telephone | 770-914-7727
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT001349
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License Number State | GA
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