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General NPI Number Information
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NPI Number | 1447238092
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Entity Type | Organization
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Legal Business Name | CAPITOL CITY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 500 UNIVERSITY AVE SUITE 200
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City | SACRAMENTO
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State | CA
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Zip | 95825-6523
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Country | US
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Telephone | 916-920-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 500 UNIVERSITY AVE SUITE 200
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City | SACRAMENTO
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State | CA
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Zip | 95825-6523
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Country | US
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Telephone | 916-920-1200
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROSE MARY ULLERY
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Credential |
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Telephone | 916-920-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 2471B0102X
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Taxonomy Name | Bone Densitometry Radiologic Technologist
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License Number |
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License Number State |
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