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General NPI Number Information
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NPI Number | 1790750065
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Entity Type | Individual
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Provider Name | LEE DOUGLASS ROBERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 255 BAPTIST BLVD STE 405
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City | COLUMBUS
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State | MS
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Zip | 39705-2004
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Country | US
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Telephone | 662-244-2288
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Fax | 662-244-2289
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Provider Business Mailing Address
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Address Line | PO BOX 405827
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City | ATLANTA
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State | GA
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Zip | 30384-5827
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Country | US
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Telephone | 901-226-3186
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Fax | 901-226-3160
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 14609
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License Number State | MS
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