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General NPI Number Information
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NPI Number | 1467066639
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Entity Type | Organization
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Legal Business Name | LUMINOUS CARE, LLC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 285 BOULEVARD NE STE 145
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City | ATLANTA
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State | GA
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Zip | 30312-4204
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Country | US
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Telephone | 844-884-9691
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Fax | 404-907-4052
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Provider Business Mailing Address
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Address Line | 1132 LIBERTY PKWY NW
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City | ATLANTA
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State | GA
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Zip | 30318-9377
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Country | US
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Telephone | 404-354-6988
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | MS. ANDREA JEFFERSON-SABOOR
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Credential |
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Telephone | 404-354-6988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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