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General NPI Number Information
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NPI Number | 1467017038
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Entity Type | Individual
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Provider Name | KHATIJA SULTANA AHMED DPM
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Gender | Female
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 1610 MULKEY RD
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City | AUSTELL
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State | GA
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Zip | 30106-1182
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Country | US
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Telephone | 707-455-1017
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Fax | 678-239-0994
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Provider Business Mailing Address
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Address Line | 1350 UPPER HEMBREE RD STE 100
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City | ROSWELL
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State | GA
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Zip | 30076-0929
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Country | US
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Telephone | 678-426-2171
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Fax | 404-446-1957
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD001530
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License Number State | GA
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