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General NPI Number Information
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NPI Number | 1740517416
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Entity Type | Organization
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Legal Business Name | PATHMEDIC LLC
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 2055 GEES MILL RD NE SUITE 326
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City | CONYERS
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State | GA
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Zip | 30013-1362
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Country | US
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Telephone | 770-679-9348
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Fax |
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Provider Business Mailing Address
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Address Line | 903 HONEY CREEK RD SE # B SUITE 275
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City | CONYERS
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State | GA
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Zip | 30094-2801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ROSELYNE O LOVELACE
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Credential |
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Telephone | 770-679-9348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 122-R-0608
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License Number State | GA
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