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General NPI Number Information
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NPI Number | 1699774083
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Entity Type | Organization
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Legal Business Name | WACH
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1061 HARMON AVE
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City | FT STEWART
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State | GA
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Zip | 31314-5604
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Country | US
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Telephone | 912-435-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 641 OAK HAMPTON RD
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City | FLEMING
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State | GA
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Zip | 31309-8433
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Country | US
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Telephone | 912-884-3955
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Fax |
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Authorized Official
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Title or Position | CLINICAL NURSE
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Name | MRS. DEBRA LEE RHEA
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Credential | RN
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Telephone | 912-435-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | RN139039
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License Number State | GA
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