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General NPI Number Information
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NPI Number | 1558402735
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Entity Type | Organization
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Legal Business Name | WILLIAM BOSTOCK , DO
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD SUITE 255
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4386
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Country | US
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Telephone | 770-963-2967
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Fax | 770-339-4585
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Provider Business Mailing Address
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Address Line | 771 OLD NORCROSS RD SUITE 255
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4386
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Country | US
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Telephone | 770-963-2967
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Fax | 770-339-4585
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KATHY BOSTOCK
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Credential |
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Telephone | 770-963-2967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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