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General NPI Number Information
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NPI Number | 1629427570
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Entity Type | Individual
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Provider Name | MWAMBA MWILA MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 1255 HIGHWAY 54 W
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4526
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Country | US
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Telephone | 404-367-3014
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Fax |
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Provider Business Mailing Address
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Address Line | 3935 ROSEMOND RD
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City | CLEVELAND HEIGHTS
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State | OH
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Zip | 44121-2446
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Country | US
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Telephone | 734-717-4865
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Fax |
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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 | 83774
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 83774
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License Number State | GA
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