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General NPI Number Information
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NPI Number | 1487133740
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Entity Type | Organization
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Legal Business Name | EVOKED IONM, LLC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 6458 MERIDIAN WAY
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-2895
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Country | US
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Telephone | 678-524-7388
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Fax | 470-407-6969
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Provider Business Mailing Address
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Address Line | 6458 MERIDIAN WAY
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-2895
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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 | PRESIDENT, CHIEF MEDICAL OFFICER
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Name | AMIT SHAH
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Credential |
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Telephone | 678-524-7388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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