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1689057879
MISTY GROVE
COLUMBUS, GA
NPI
1689057879
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: GA RN170056)
Enumeration Date
2015-07-07
Last Update Date
2015-07-07
Business Address
-- MISTY GROVE
2122 MANCHESTER EXPY
COLUMBUS, GA 31904-6878
Phone number: 706-320-2773
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Mailing Address
-- MISTY GROVE
PO BOX 8147
COLUMBUS, GA 31908-8147
Phone number: 706-320-2773
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