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General NPI Number Information
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NPI Number | 1629202874
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE AGENCY INC
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Dates
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Enumeration Date | 05/03/2009
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 110 EAGLE SPRING DR SUITE D
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-2568
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Country | US
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Telephone | 770-310-8794
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Fax | 678-961-5719
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Provider Business Mailing Address
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Address Line | 110 EAGLE SPRING DR SUITE D
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6488
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Country | US
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Telephone | 770-310-8794
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Fax | 678-961-5719
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MRS. RUFINA NORAGBON
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Credential | RN
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Telephone | 770-310-8794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | RN165113
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License Number State | GA
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