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General NPI Number Information
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NPI Number | 1437363751
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Entity Type | Organization
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Legal Business Name | AOG AESTHETICS
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1105 BURLEYSON RD SUITE 1
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City | DALTON
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State | GA
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Zip | 30720-3017
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Country | US
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Telephone | 706-226-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 BURLEYSON RD SUITE 1
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City | DALTON
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State | GA
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Zip | 30720-3017
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Country | US
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Telephone | 706-226-7546
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | CAROLE BRIDGES
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Credential |
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Telephone | 706-278-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 012695
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License Number State | GA
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