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General NPI Number Information
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NPI Number | 1922119163
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Entity Type | Organization
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Legal Business Name | ATL VA MEDICAL CENTER
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-321-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 4657 BEXLEY DR
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-5560
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Country | US
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Telephone | 770-808-1598
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Fax |
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | MS. ANNA JOHNSON
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Credential |
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Telephone | 404-321-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | RN099782
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License Number State | GA
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