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General NPI Number Information
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NPI Number | 1982374989
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Entity Type | Individual
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Provider Name | MICHELLE EHIZOGIE IGORI
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Gender | Female
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 6969 ARAPAHO RD
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City | DALLAS
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State | TX
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Zip | 75248-4044
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Country | US
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Telephone | 469-495-9132
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Fax | 468-495-0732
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Provider Business Mailing Address
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Address Line | 3330 CUMBERLAND BLVD SE STE 825
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City | ATLANTA
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State | GA
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Zip | 30339-7009
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11477
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18291
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License Number State | TX
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