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General NPI Number Information
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NPI Number | 1467637538
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Entity Type | Organization
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Legal Business Name | MATTHEW J. NOVAK, MD, P.C.
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 780 CANTON RD NE SUITE 320
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City | MARIETTA
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State | GA
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Zip | 30060-7241
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Country | US
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Telephone | 770-794-1995
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Fax | 770-794-1996
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Provider Business Mailing Address
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Address Line | 50 BARRETT PKWY SUITE 1200, # 338
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City | MARIETTA
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State | GA
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Zip | 30066-3300
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Country | US
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Telephone | 770-794-1995
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Fax | 770-794-1996
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW J NOVAK
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Credential | M.D.
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Telephone | 770-794-1995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 048552
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License Number State | GA
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