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General NPI Number Information
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NPI Number | 1790226546
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Entity Type | Organization
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Legal Business Name | ELITE HYDRATION CENTER
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 4200 NORTHSIDE PKWY NW BLDG 8 SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30327-3007
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Country | US
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Telephone | 404-935-2189
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Fax |
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Provider Business Mailing Address
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Address Line | 245 N HIGHLAND AVE NE STE 230-451
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City | ATLANTA
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State | GA
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Zip | 30307-1936
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Country | US
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Telephone | 404-935-2189
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | MR. ADAM SMART
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Credential | CSA
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Telephone | 404-935-2189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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