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General NPI Number Information
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NPI Number | 1922984673
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Entity Type | Organization
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Legal Business Name | DERMACCEL
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 119 WATTERSON PKWY
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2307
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Country | US
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Telephone | 919-270-3277
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 59027
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City | BIRMINGHAM
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State | AL
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Zip | 35259-9027
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Country | US
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Telephone | 919-270-3277
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN JAMES WADE
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Credential |
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Telephone | 919-270-3277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2278C0205X
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Taxonomy Name | Critical Care Certified Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2278P1005X
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Taxonomy Name | Pulmonary Rehabilitation Certified Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2278P3900X
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Taxonomy Name | Neonatal/Pediatric Certified Respiratory Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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