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General NPI Number Information
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NPI Number | 1518782374
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Entity Type | Organization
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Legal Business Name | VELO MEDICAL GROUP LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 301 GWINNETT DRIVE
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 770-910-9196
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Fax | 770-910-9197
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Provider Business Mailing Address
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Address Line | 301 GWINNETT DR SW, LAWRENCEVILLE, GA 30046
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5669
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Country | US
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Telephone | 770-910-9196
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Fax | 770-910-9197
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | AFIYAH HASHMI
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Credential |
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Telephone | 770-910-9196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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