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General NPI Number Information
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NPI Number | 1629074299
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Entity Type | Individual
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Provider Name | NIMISHA J TRIVEDI MD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 3778 HIGHWAY 42
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City | LOCUST GROVE
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State | GA
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Zip | 30248
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Country | US
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Telephone | 678-610-6649
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Fax | 678-610-6025
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Provider Business Mailing Address
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Address Line | 3778 HIGHWAY 42
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City | LOCUST GROVE
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State | GA
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Zip | 30248
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Country | US
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Telephone | 678-610-6649
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Fax | 678-610-6025
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 053715
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 053715
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License Number State | GA
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