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General NPI Number Information
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NPI Number | 1568641165
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Entity Type | Organization
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Legal Business Name | CAROMONT MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 519 NAUTICAL DR STE 100A
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City | CLOVER
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State | SC
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Zip | 29710-8113
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Country | US
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Telephone | 803-631-2858
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Fax | 803-631-2862
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Provider Business Mailing Address
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Address Line | PO BOX 744786
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City | ATLANTA
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State | GA
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Zip | 30374-4786
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Country | US
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Telephone | 704-834-2450
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Fax | 803-631-2862
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Authorized Official
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Title or Position | CFO
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Name | DAVID MICHAEL OCONNOR
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Credential |
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Telephone | 704-671-5343
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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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