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General NPI Number Information
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NPI Number | 1831274034
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Entity Type | Organization
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Legal Business Name | ADVANCED DIGESTIVE CARE CENTER,P.C.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 235 MEDICAL BLVD SUITE A
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7218
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Country | US
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Telephone | 678-783-0300
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Fax | 678-565-9473
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Provider Business Mailing Address
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Address Line | 235 MEDICAL BLVD SUITE A
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 678-783-0300
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Fax | 678-565-9473
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CELESTINE MAIKI
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Credential | M.D.
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Telephone | 678-783-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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