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General NPI Number Information
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NPI Number | 1770121030
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Entity Type | Organization
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Legal Business Name | NEW LIFE MEDICAL CENTERS GEORGIA LLC
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 3550 LENOX RD NE STE 2100
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City | ATLANTA
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State | GA
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Zip | 30326-1810
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Country | US
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Telephone | 404-806-5575
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Fax |
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Provider Business Mailing Address
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Address Line | 227 N MAIN ST
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2310
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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 | OWNER
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Name | ARTHUR ELLIOT HIRSHORN III
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Credential |
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Telephone | 864-881-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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