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General NPI Number Information
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NPI Number | 1942724885
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Entity Type | Organization
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Legal Business Name | GATEWAY CLINIC, LLC
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 08/02/2017
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Provider Practice Location Address
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Address Line | 7999 PHILIPS HWY SUITE 305
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City | JACKSONVILLE
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State | FL
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Zip | 32256
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Country | US
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Telephone | 904-503-9646
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Fax |
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Provider Business Mailing Address
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Address Line | 7999 PHILIPS HWY STE 305
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRISTOPHER BRANCH
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Credential |
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Telephone | 404-422-4262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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