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General NPI Number Information
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NPI Number | 1477613172
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Entity Type | Organization
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Legal Business Name | MEMORIAL FAMILY PRACTICE ASSOCIATES
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 3546 ST JOHNS BLUFF ROAD SOUTH SUITE 108
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City | JACKSONVILLE
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State | FL
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Zip | 32224
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Country | US
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Telephone | 904-306-8067
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 277272
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City | ATLANTA
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State | GA
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Zip | 30384-7272
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PAULA BUCKINGHAM
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Credential |
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Telephone | 904-306-8067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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