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General NPI Number Information
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NPI Number | 1922272996
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Entity Type | Organization
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Legal Business Name | FAMILY FIRST HEALTH CENTER
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 04/21/2008
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Provider Practice Location Address
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Address Line | 1898 S CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-1579
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Country | US
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Telephone | 386-492-1064
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Fax |
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Provider Business Mailing Address
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Address Line | 788 IOWA ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1428
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Country | US
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Telephone | 502-608-4340
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. DELICIA MONE' HAYNES
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Credential | M.D.
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Telephone | 386-492-1064
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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 |
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License Number State |
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