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General NPI Number Information
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NPI Number | 1770769242
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Entity Type | Organization
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Legal Business Name | BONNE SANTE MEDICAL LLC
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 2221 PEACHTREE RD NE SUITE D 195
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City | ATLANTA
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State | GA
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Zip | 30309-1148
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Country | US
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Telephone | 770-994-0171
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Fax | 770-507-4190
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Provider Business Mailing Address
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Address Line | 2221 PEACHTREE RD NE SUITE D-195
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City | ATLANTA
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State | GA
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Zip | 30309-1148
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Country | US
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Telephone | 770-994-0171
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Fax | 770-507-4190
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | WAINDEL BELIZAIRE
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Credential | DO
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Telephone | 770-994-0171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 052252
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License Number State | GA
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