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General NPI Number Information
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NPI Number | 1689298457
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Entity Type | Organization
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Legal Business Name | NORTHEAST GEORGIA OPHTHALMOLOGY, LLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 1498 JESSE JEWELL PKWY SE STE B
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City | GAINESVILLE
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State | GA
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Zip | 30501-3874
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Country | US
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Telephone | 770-596-8605
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Fax | 713-903-7907
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Provider Business Mailing Address
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Address Line | 195 14TH ST NE UNIT 805
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City | ATLANTA
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State | GA
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Zip | 30309-2673
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Country | US
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Telephone | 770-596-8605
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Fax | 713-903-7907
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | VANDANA C. REDDY
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Credential | MD
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Telephone | 770-767-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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