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General NPI Number Information
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NPI Number | 1548445802
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE PHYSICIAN CENTER, PC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 5197 ROSWELL RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-2213
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Country | US
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Telephone | 404-477-4712
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Fax |
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Provider Business Mailing Address
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Address Line | 5197 ROSWELL RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-2213
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Country | US
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Telephone | 404-477-4712
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. BEN D. THOMAS JR.
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Credential | MD
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Telephone | 404-252-1230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 23118
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License Number State | GA
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