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General NPI Number Information
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NPI Number | 1821115650
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Entity Type | Organization
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Legal Business Name | SOUTHEAST HEALTHCARE LLC
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Dates
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Enumeration Date | 03/25/2007
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Last Update Date | 10/24/2008
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Provider Practice Location Address
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Address Line | 2759 DELK RD SE STE 2135
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City | MARIETTA
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State | GA
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Zip | 30067-8860
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Country | US
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Telephone | 770-439-8990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1304
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-7304
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Country | US
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Telephone | 770-439-8990
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOY I UBANI
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Credential | NURSE
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Telephone | 770-439-8990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | GA
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