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General NPI Number Information
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NPI Number | 1992433882
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Entity Type | Organization
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Legal Business Name | RESTOR DIABETES CARE LLC
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 300 PARKBROOKE PL STE 150
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City | WOODSTOCK
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State | GA
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Zip | 30189-7280
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Country | US
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Telephone | 706-395-6451
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Fax |
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Provider Business Mailing Address
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Address Line | 394 S MILLEDGE AVE STE 101
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City | ATHENS
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State | GA
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Zip | 30605-5626
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Country | US
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Telephone | 706-395-6451
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | MELISSA HOOD
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Credential |
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Telephone | 912-590-2184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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