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General NPI Number Information
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NPI Number | 1730303827
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Entity Type | Organization
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Legal Business Name | GARY B GARISON M.D. P.A.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 3625 CAPE CENTER DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4457
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Country | US
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Telephone | 910-587-9590
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Fax | 919-287-2269
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Provider Business Mailing Address
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Address Line | 3688 PIONEER DR
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City | HOPE MILLS
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State | NC
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Zip | 28348-9346
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Country | US
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Telephone | 910-587-9590
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Fax | 919-287-2269
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KANDI S GREER
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Credential | MSHM
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Telephone | 910-587-9590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 16785
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License Number State | NC
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