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General NPI Number Information
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NPI Number | 1871885806
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Entity Type | Organization
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Legal Business Name | UNIVERSITY MEDICAL GROUP LLC
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 3486 PEACH ORCHARD RD STE 100
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City | AUGUSTA
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State | GA
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Zip | 30906-5215
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Country | US
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Telephone | 706-828-8000
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Fax | 706-828-8001
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Provider Business Mailing Address
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Address Line | P O BOX 1705
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City | AUGUSTA
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State | GA
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Zip | 30903-1705
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Country | US
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Telephone | 706-774-7263
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Fax | 706-774-7230
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Authorized Official
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Title or Position | DIRECTOR. PHYSICIAN REVENUE CYCLE
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Name | JULIE DEASON
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Credential |
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Telephone | 706-774-8326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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