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General NPI Number Information
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NPI Number | 1821263963
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Entity Type | Organization
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Legal Business Name | ALLIED ANKLE & FOOTCARE CENTERS PC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 15 HURRICANE SHOALS RD NE SUITE B
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4454
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Country | US
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Telephone | 770-277-7373
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Fax | 770-277-1755
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Provider Business Mailing Address
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Address Line | PO BOX 491658
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City | LAWRENCEVILLE
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State | GA
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Zip | 30049-0028
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Country | US
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Telephone | 770-255-0420
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Fax | 770-255-0425
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JAMES LOUIS BOUCHARD
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Credential | DPM
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Telephone | 770-255-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD000418
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License Number State | GA
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