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General NPI Number Information
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NPI Number | 1699401463
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Entity Type | Individual
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Provider Name | LEIA MITCHELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 4800 OLDE TOWNE PKWY STE 370
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City | MARIETTA
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State | GA
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Zip | 30068-4396
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Country | US
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Telephone | 678-631-4620
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Fax |
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Provider Business Mailing Address
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Address Line | 1066 STOVALL BLVD NE
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City | ATLANTA
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State | GA
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Zip | 30319-1221
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Country | US
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Telephone | 423-290-3941
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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