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General NPI Number Information
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NPI Number | 1548517253
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Entity Type | Organization
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Legal Business Name | ALPHA MEDICAL CLINIC
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 5 HURRICANE SHOALS RD NE STE A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4583
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Country | US
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Telephone | 229-630-0407
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 416
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City | SUWANEE
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State | GA
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Zip | 30024-0416
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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
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Name | DR. LOUIS A UWAGERIKPE
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Credential | M.D.
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Telephone | 229-630-0407
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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 | 56779
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License Number State | GA
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