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General NPI Number Information
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NPI Number | 1760615280
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Entity Type | Organization
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Legal Business Name | ABSOLUTE FAMILY PCH
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 2035 OLD SAVANNAH RD.
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City | AUGUSTA
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State | GA
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Zip | 30901
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Country | US
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Telephone | 706-394-8093
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Fax |
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Provider Business Mailing Address
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Address Line | 2516 COLEMAN AVE.
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City | AUGUSTA
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State | GA
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Zip | 30906
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Country | US
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Telephone | 706-364-7588
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Fax | 706-364-7588
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PHILANDIS WIMBUSH
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Credential |
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Telephone | 706-394-8093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 121013181
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License Number State | GA
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