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General NPI Number Information
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NPI Number | 1841304797
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Entity Type | Organization
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Legal Business Name | SOUTH GEORGIA ENDOSCOPY CENTER, INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 1501 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-4530
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Country | US
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Telephone | 912-285-0877
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Fax | 912-287-0387
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Provider Business Mailing Address
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Address Line | 1501 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-4530
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Country | US
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Telephone | 912-285-0877
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Fax | 912-287-0387
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Authorized Official
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Title or Position | OWNER
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Name | SOHAIL A CHOUDHRI
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Credential | M.D.
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Telephone | 912-285-0877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 148228
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License Number State | GA
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