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General NPI Number Information
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NPI Number | 1922605971
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Entity Type | Organization
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Legal Business Name | YOUR VIRTUAL CLINIC PA
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 601 21ST ST STE 300
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City | VERO BEACH
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State | FL
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Zip | 32960-0860
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Country | US
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Telephone | 888-210-3339
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Fax |
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Provider Business Mailing Address
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Address Line | 450 OLD PEACHTREE RD NW STE 101
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City | SUWANEE
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State | GA
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Zip | 30024-7289
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Country | US
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Telephone | 888-210-3339
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KEVIN F SMITH
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Credential | MD
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Telephone | 770-286-9149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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