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General NPI Number Information
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NPI Number | 1669607891
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Entity Type | Organization
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Legal Business Name | WEST GEORGIA FAMILY PRACTICE P.C
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 301 MEDICAL DR SUITE 503
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City | LAGRANGE
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State | GA
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Zip | 30240-4144
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Country | US
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Telephone | 678-867-7630
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Fax |
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Provider Business Mailing Address
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Address Line | 301 MEDICAL DR SUITE 503
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City | LAGRANGE
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State | GA
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Zip | 30240-4144
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Country | US
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Telephone | 706-882-2447
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Fax | 706-882-2473
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Authorized Official
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Title or Position | OWNER
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Name | SRINIVAS RAO BRAMHADEVI
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Credential | M.D
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Telephone | 678-867-7630
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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 | 061946
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License Number State | GA
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