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General NPI Number Information
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NPI Number | 1770830804
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH AND WELLNESS GROUP
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 607 W DUE WEST AVE SUITE 105
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City | MADISON
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State | TN
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Zip | 37115-4431
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Country | US
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Telephone | 615-891-4903
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Fax | 615-864-8671
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Provider Business Mailing Address
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Address Line | 607 W DUE WEST AVE SUITE 105
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City | MADISON
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State | TN
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Zip | 37115-4431
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Country | US
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Telephone | 615-891-4903
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Fax | 615-864-8671
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALLISION PATRICE PUCKETT
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Credential | MD
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Telephone | 615-585-9305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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