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General NPI Number Information
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NPI Number | 1285439737
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Entity Type | Individual
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Provider Name | TYRIK DEVON WEAVER BACHELORS
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Gender | Male
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 1074 S MAIN ST NE
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City | CONYERS
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State | GA
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Zip | 30012-4847
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Country | US
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Telephone | 762-815-9295
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Fax |
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Provider Business Mailing Address
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Address Line | 1315 BILLUPS ST
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City | MADISON
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State | GA
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Zip | 30650-1126
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Country | US
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Telephone | 762-815-9295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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