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General NPI Number Information
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NPI Number | 1679464143
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Entity Type | Organization
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Legal Business Name | CITY PSYCHIATRY LLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 2219 CARSON VALLEY DR
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City | TUCKER
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State | GA
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Zip | 30084-3106
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Country | US
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Telephone | 404-964-5415
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Fax | 854-228-6420
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Provider Business Mailing Address
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Address Line | 2219 CARSON VALLEY DR
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City | TUCKER
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State | GA
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Zip | 30084-3106
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Country | US
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Telephone | 404-964-5415
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Fax | 854-228-6420
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Authorized Official
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Title or Position | PA-C / MINORITY OWNER
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Name | KASARA AL HELOU
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Credential | PA-C
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Telephone | 404-964-5415
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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