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General NPI Number Information
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NPI Number | 1245607530
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Entity Type | Organization
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Legal Business Name | JAYVELIYATHMDINC
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Dates
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Enumeration Date | 08/21/2015
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Last Update Date | 08/21/2015
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Provider Practice Location Address
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Address Line | 2155 POST OAK TRITT RD STE580
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City | MARIETTA
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State | GA
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Zip | 30062-8620
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Country | US
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Telephone | 770-971-0633
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Fax | 770-971-3182
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Provider Business Mailing Address
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Address Line | 2155 POST OAK TRITT RD STE580
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City | MARIETTA
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State | GA
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Zip | 30062-8620
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Country | US
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Telephone | 770-971-0633
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Fax | 770-971-3182
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Authorized Official
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Title or Position | CEO
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Name | DR. JAYASHREE C VELIYATH
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Credential | MD
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Telephone | 770-971-0633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 38638
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License Number State | GA
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