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General NPI Number Information
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NPI Number | 1801116819
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Entity Type | Individual
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Provider Name | JONATHAN JAMES GRIES M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 141 HILDEN RD STE 201
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City | PONTE VEDRA
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State | FL
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Zip | 32081-8400
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Country | US
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Telephone | 904-825-1941
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Fax | 904-390-7460
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Provider Business Mailing Address
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Address Line | PO BOX 746638
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City | ATLANTA
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State | GA
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Zip | 30374-6638
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Country | US
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Telephone | 904-202-1032
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Fax | 904-376-4107
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01072798A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME161420
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License Number State | FL
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