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General NPI Number Information
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NPI Number | 1548072580
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Entity Type | Organization
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Legal Business Name | MEDIMPROVE CLINICAL LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 371 E PACES FERRY RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-2372
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Country | US
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Telephone | 646-285-3174
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Fax |
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Provider Business Mailing Address
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Address Line | 371 E PACES FERRY RD NE
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City | ATLANTA
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State | GA
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Zip | 30305-2372
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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 | CHIEF ADMINISTRATIVE OFFICER
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Name | JAN DE BACKER
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Credential |
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Telephone | 646-258-3174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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