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General NPI Number Information
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NPI Number | 1922272012
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Entity Type | Organization
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Legal Business Name | FOOT AND ANKLE CENTER OF AUGUSTA
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 1142 DRUID PARK AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-5850
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Country | US
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Telephone | 706-739-0020
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Fax | 706-739-0024
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Provider Business Mailing Address
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Address Line | 1142 DRUID PARK AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-5850
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Country | US
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Telephone | 706-739-0020
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Fax | 706-739-0024
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LATANYA FYNE
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Credential | MD
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Telephone | 706-739-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000619
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000619
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License Number State | GA
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