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General NPI Number Information
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NPI Number | 1871741389
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Entity Type | Organization
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Legal Business Name | GEORGIA MUA, LLC
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 1276 MCCONNELL DR STE. A&B
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City | DECATUR
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State | GA
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Zip | 30033-3508
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Country | US
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Telephone | 404-348-4348
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Fax | 877-451-8595
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Provider Business Mailing Address
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Address Line | 1276 MCCONNELL DR STE. A&B
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City | DECATUR
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State | GA
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Zip | 30033-3508
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KEVIN SMITH
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Credential | MD
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Telephone | 404-788-6140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 008268
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 041961
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License Number State | GA
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