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General NPI Number Information
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NPI Number | 1881754307
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Entity Type | Organization
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Legal Business Name | EMERGENCY MEDICAL SPECIALIST
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4800 48TH ST
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City | VALLEY
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State | AL
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Zip | 36854-3666
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Country | US
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Telephone | 334-756-9180
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 686
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City | WEST POINT
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State | GA
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Zip | 31833-0686
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Country | US
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Telephone | 706-643-1073
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Fax | 706-643-1070
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Authorized Official
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Title or Position | CEO
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Name | DR. MAX RONALD SHIVER
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Credential |
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Telephone | 706-643-1073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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