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General NPI Number Information
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NPI Number | 1124615737
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Entity Type | Organization
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Legal Business Name | HOLISTIC ATLANTA
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 6886 MAIN ST
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City | STONECREST
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State | GA
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Zip | 30058-4508
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Country | US
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Telephone | 404-808-0870
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Fax | 470-201-1205
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Provider Business Mailing Address
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Address Line | 3247 ROCKVIEW DR STE A
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City | STONECREST
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State | GA
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Zip | 30038-3032
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Country | US
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Telephone | 404-808-0870
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. VAUGHN GAY
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Credential | DSW, LPC
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Telephone | 404-808-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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