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General NPI Number Information
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NPI Number | 1831352574
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Entity Type | Organization
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Legal Business Name | ALLERGY & ASTHMA CENTER OF MIDDLE GEORGIA, INC.
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 3964 ELNORA DR
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City | MACON
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State | GA
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Zip | 31210-1825
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Country | US
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Telephone | 478-477-1777
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Fax | 478-477-1779
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Provider Business Mailing Address
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Address Line | 3964 ELNORA DR
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City | MACON
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State | GA
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Zip | 31210-1825
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Country | US
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Telephone | 478-477-1777
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Fax | 478-477-1779
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. RAHUL KUMAR VANGALA
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Credential | M.D.
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Telephone | 478-477-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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