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General NPI Number Information
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NPI Number | 1720023500
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Entity Type | Organization
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Legal Business Name | CENTER FOR RECONSTRUCTIVE SURGERY
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 7130 MOUNT ZION BLVD SUITE 14
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City | JONESBORO
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State | GA
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Zip | 30236-2518
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Country | US
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Telephone | 770-716-8732
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Fax | 770-716-1330
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Provider Business Mailing Address
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Address Line | 7130 MOUNT ZION BLVD SUITE 14
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City | JONESBORO
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State | GA
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Zip | 30236-2518
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Country | US
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Telephone | 770-716-8732
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Fax | 770-716-1330
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. GREGORY ALVAREZ
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Credential | DPM
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Telephone | 770-487-6716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 060-083
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License Number State | GA
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