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General NPI Number Information
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NPI Number | 1093456048
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Entity Type | Organization
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Legal Business Name | PSYCLE DOC LLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 755 MOUNT VERNON HWY NE STE 220
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-4277
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Country | US
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Telephone | 208-850-3061
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Fax |
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Provider Business Mailing Address
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Address Line | 4780 TALL PINES DR NW
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City | ATLANTA
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State | GA
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Zip | 30327-3328
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Country | US
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Telephone | 208-850-3061
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAREN ELAINE GILES
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Credential | MD
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Telephone | 208-850-3061
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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 |
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License Number State |
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