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General NPI Number Information
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NPI Number | 1821120072
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Entity Type | Individual
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Provider Name | HEATHER ALICIA HANCOCK MD
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-984-5020
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Fax | 601-984-5042
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Provider Business Mailing Address
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Address Line | 310 DOVER LN
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City | MADISON
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State | MS
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Zip | 39110-9418
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Country | US
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Telephone | 901-491-9952
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 43457
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License Number State | TN
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