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General NPI Number Information
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NPI Number | 1700965175
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Entity Type | Individual
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Provider Name | STACEY CATHLEEN HEIT MD
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Gender | Female
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Dates
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Enumeration Date | 11/04/2006
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 11755 POINTE PL SUITE A1
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City | ROSWELL
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State | GA
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Zip | 30076-4636
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Country | US
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Telephone | 770-667-1264
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Fax | 770-667-2238
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Provider Business Mailing Address
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Address Line | NORTHSIDE HOSPITAL- MANAGED CARE DEPT 1000 JOHNSON FERRY RD
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City | ATLANTA
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State | GA
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Zip | 30342-1606
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Country | US
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Telephone | 404-300-2476
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Fax | 404-250-8010
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 41307
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License Number State | GA
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