=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528460870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAILY DBT LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2014
-----------------------------------------------------
Last Update Date | 09/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1409 N HIGHLAND AVE NE STE J
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30306-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-550-5879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1409 N HIGHLAND AVE NE STE J
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30306-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-550-5879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | DR. LAUREN EDWARDS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 404-550-5879
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY003475
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------