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General NPI Number Information
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NPI Number | 1194378745
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Entity Type | Organization
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Legal Business Name | GEORGIA THERAPY CLINIC, LLC
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 1800 PEACHTREE ST NW STE 730
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City | ATLANTA
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State | GA
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Zip | 30309-2511
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Country | US
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Telephone | 470-481-6200
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Fax | 404-257-6297
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Provider Business Mailing Address
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Address Line | 1800 PEACHTREE ST NW STE 730
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City | ATLANTA
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State | GA
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Zip | 30309-2511
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Country | US
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Telephone | 470-481-6200
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Fax | 404-257-6297
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | KATHY CRUISE
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Credential |
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Telephone | 832-602-6545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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