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General NPI Number Information
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NPI Number | 1821405986
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Entity Type | Organization
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Legal Business Name | ML PREMIUM NURSING SERVICE
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 5376 STONE COVE DR SW
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City | ATLANTA
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State | GA
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Zip | 30331-8917
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Country | US
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Telephone | 770-899-8393
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Fax | 404-549-2450
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Provider Business Mailing Address
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Address Line | 5376 STONE COVE DR SW
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City | ATLANTA
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State | GA
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Zip | 30331-8917
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Country | US
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Telephone | 770-899-8393
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Fax | 404-549-2450
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Authorized Official
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Title or Position | CEO
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Name | MR. RYAN LEE
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Credential |
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Telephone | 770-899-8393
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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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