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General NPI Number Information
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NPI Number | 1912358110
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Entity Type | Organization
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Legal Business Name | SOUTHEAST SERVICES, LLC
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 1983 LAKE SHADOW WAY
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City | SUWANEE
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State | GA
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Zip | 30024-4311
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Country | US
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Telephone | 678-908-5919
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Fax | 770-822-2337
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Provider Business Mailing Address
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Address Line | 1983 LAKE SHADOW WAY
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City | SUWANEE
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State | GA
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Zip | 30024-4311
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Country | US
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Telephone | 678-908-5919
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Fax | 770-822-2337
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SALIM KABA
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Credential |
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Telephone | 678-908-5919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 067-R-1279
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License Number State | GA
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