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General NPI Number Information
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NPI Number | 1851538573
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Entity Type | Organization
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Legal Business Name | TRINITY TREATMENT CENTER, INC
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 1221 NEWBERG AVE
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City | MACON
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State | GA
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Zip | 31206-3011
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Country | US
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Telephone | 478-788-5600
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Fax | 478-788-5660
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Provider Business Mailing Address
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Address Line | PO BOX 3613
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City | MACON
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State | GA
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Zip | 31205-3613
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Country | US
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Telephone | 478-788-5600
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Fax | 478-788-5660
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | MRS. KARINE ALLEYNE
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Credential | R.PH
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Telephone | 478-788-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | NTP001036
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License Number State | GA
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