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General NPI Number Information
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NPI Number | 1588425078
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Entity Type | Organization
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Legal Business Name | HAVEN AUTISM
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 125 CLAIREMONT AVE STE 205
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City | DECATUR
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State | GA
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Zip | 30030-2558
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Country | US
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Telephone | 678-210-7070
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Fax | 404-745-0106
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Provider Business Mailing Address
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Address Line | 125 CLAIREMONT AVE STE 205
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City | DECATUR
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State | GA
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Zip | 30030-2558
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Country | US
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Telephone | 678-210-7070
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Fax | 404-745-0106
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYON EVANS
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Credential | MD
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Telephone | 770-312-9435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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