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General NPI Number Information
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NPI Number | 1629432455
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Entity Type | Organization
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Legal Business Name | ADVANCED WEIGHT LOSS AND MED CARE CENTER, LLC
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 371 E PACES FERRY RD NE STE 750
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City | ATLANTA
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State | GA
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Zip | 30305-2372
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Country | US
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Telephone | 770-487-3200
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Fax | 229-516-1440
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Provider Business Mailing Address
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Address Line | 504 WALDO ST SE
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City | ATLANTA
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State | GA
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Zip | 30312-3424
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Country | US
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Telephone | 770-487-3200
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Fax | 229-516-1440
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER ROBINSON
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Credential | FNP-C
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Telephone | 404-275-2552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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