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General NPI Number Information
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NPI Number | 1922292853
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Entity Type | Organization
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Legal Business Name | DIRECT HEALTHCARE & SUPPLIES SERVICE, LLC
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 3429 LAWRENCEVILLE BLG 1000 SUITE A
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City | SUWANEE
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State | GA
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Zip | 30024
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Country | US
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Telephone | 770-831-7758
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Fax |
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Provider Business Mailing Address
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Address Line | 1362 NICHOLSON PL
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City | SUWANEE
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State | GA
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Zip | 30024-8301
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Country | US
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Telephone | 770-831-7758
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Fax |
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Authorized Official
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Title or Position | REGISTER NURSE
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Name | MRS. MARTHA U ANYAORAH
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Credential | RN
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Telephone | 770-831-7758
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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 |
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License Number State | GA
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