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General NPI Number Information
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NPI Number | 1689197378
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Entity Type | Organization
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Legal Business Name | CVG PHYSICIANS GROUP, LLC
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 755 WALTHER RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8725
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Country | US
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Telephone | 770-962-0399
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Fax | 770-995-0533
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Provider Business Mailing Address
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Address Line | 2100 RIVERSIDE PKWY STE 119B-319
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5927
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTING MANAGER
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Name | MANFRED SANDLER
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Credential | MD
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Telephone | 770-962-0399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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