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General NPI Number Information
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NPI Number | 1982880019
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Entity Type | Organization
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Legal Business Name | HERITAGE MEDICAL SOLUTIONS, INC.
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 4330 SOUTH LEE STREET BLDG 600
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City | BUFORD
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State | GA
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Zip | 30518-5754
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Country | US
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Telephone | 678-889-4944
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Fax | 678-889-4946
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Provider Business Mailing Address
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Address Line | 4330 SOUTH LEE STREET BLDG 600
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City | BUFORD
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State | GA
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Zip | 30518-5754
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Country | US
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Telephone | 678-889-4944
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Fax | 678-889-4946
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Authorized Official
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Title or Position | PRESIDENT/C.E.O
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Name | MR. STEVE AJONY
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Credential | B.S./HND
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Telephone | 678-889-4944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 047776
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License Number State | GA
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