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General NPI Number Information
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NPI Number | 1881704773
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Entity Type | Organization
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Legal Business Name | THE UROLOGY INSTITUTE AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 817 SMITH AVENUE
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City | THOMASVILLE
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State | GA
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Zip | 31792
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Country | US
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Telephone | 229-227-0086
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Fax | 229-227-5929
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Provider Business Mailing Address
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Address Line | PO BOX 2155
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City | THOMASVILLE
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State | GA
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Zip | 31799
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Country | US
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Telephone | 229-227-0086
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Fax | 229-227-5929
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Authorized Official
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Title or Position | CEO
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Name | MARSHA D GLOVER
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Credential | MD
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Telephone | 229-227-0086
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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 |
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License Number State |
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