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General NPI Number Information
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NPI Number | 1598058885
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Entity Type | Organization
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Legal Business Name | THE ULTIMATE WELLNESS GROUP
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 12400 SHADOW CREEK PKWY UNIT 3306
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City | PEARLAND
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State | TX
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Zip | 77584-7347
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Country | US
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Telephone | 832-429-4576
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Fax |
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Provider Business Mailing Address
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Address Line | 6614 STEARNS ST
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City | HOUSTON
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State | TX
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Zip | 77021-2418
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Country | US
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Telephone | 832-429-4576
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AKILI GRAHAM
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Credential | MD
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Telephone | 832-429-4576
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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 | K7161
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License Number State | TX
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