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General NPI Number Information
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NPI Number | 1205352093
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Entity Type | Organization
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Legal Business Name | ELITE ROSE HEALTHCARE SERVICES P.C.
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2783 SANTA BARBARA DR NW
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City | ATLANTA
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State | GA
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Zip | 30318-7326
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Country | US
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Telephone | 404-944-1174
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Fax |
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Provider Business Mailing Address
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Address Line | 2783 SANTA BARBARA DR NW
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City | ATLANTA
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State | GA
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Zip | 30318-7326
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | AYJANAH RASHEEDA MOORE
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Credential | NP-C
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Telephone | 404-944-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | APRN207446
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License Number State | GA
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