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General NPI Number Information
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NPI Number | 1922071943
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Entity Type | Individual
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Provider Name | STEPHEN C. JO MD
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 1200 MEMORIAL DR
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City | DALTON
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State | GA
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Zip | 30720-2529
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Country | US
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Telephone | 706-272-6876
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Fax | 706-272-6877
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Provider Business Mailing Address
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Address Line | 9343 BENNIE LN
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City | OOLTEWAH
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State | TN
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Zip | 37363-8968
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Country | US
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Telephone | 757-642-2909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101233681
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 0101233681
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License Number State | VA
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