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General NPI Number Information
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NPI Number | 1427851708
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Entity Type | Organization
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Legal Business Name | BADIA HEALTHCARE
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 2001 MELROSE PL
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City | KATHLEEN
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State | GA
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Zip | 31047-2873
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Country | US
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Telephone | 615-738-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 MELROSE PL
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City | KATHLEEN
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State | GA
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Zip | 31047-2873
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Country | US
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Telephone | 615-738-6463
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ASHLEY DEFORE
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Credential |
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Telephone | 478-508-3308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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