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General NPI Number Information
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NPI Number | 1548680796
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Entity Type | Organization
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Legal Business Name | EMORY PHYSICIANS GROUP, LLC
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 22 14TH STREET NW SPACE 129
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City | ATLANTA
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State | GA
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Zip | 30309
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Country | US
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Telephone | 404-504-6554
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Fax | 404-999-7964
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Provider Business Mailing Address
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Address Line | PO BOX 102404
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City | PASADENA
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State | CA
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Zip | 91189-2404
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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 | DIRECTOR
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Name | STEPHANIE VICENT
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Credential |
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Telephone | 404-778-5352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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