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General NPI Number Information
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NPI Number | 1457670663
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Entity Type | Organization
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Legal Business Name | MARCUS AUTISM CENTER
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 1920 BRIARCLIFF RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-4010
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Country | US
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Telephone | 404-785-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 BRIARCLIFF RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-4010
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Country | US
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Telephone | 404-785-9400
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | DAVID JAQUESS
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Credential | PHD
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Telephone | 404-785-9443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 003405
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License Number State | GA
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