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General NPI Number Information
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NPI Number | 1497953012
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Entity Type | Organization
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Legal Business Name | VA MEDICAL CENTER
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1401 POST OAK DR APT F
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City | CLARKSTON
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State | GA
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Zip | 30021-3145
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Country | US
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Telephone | 404-808-3229
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33622
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City | DECATUR
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State | GA
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Zip | 30033-0622
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Country | US
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Telephone | 404-808-3229
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MS. LEA MICHELLE WALKER
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Credential |
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Telephone | 404-808-3229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | LPN074690
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License Number State | GA
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