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General NPI Number Information
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NPI Number | 1790393684
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Entity Type | Organization
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Legal Business Name | RECLAIMU HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 2037 EMA DELL PL
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City | LOGANVILLE
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State | GA
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Zip | 30052-5375
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Country | US
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Telephone | 678-568-9377
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | SNELLVILLE
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State | GA
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Zip | 30078-0220
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Country | US
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Telephone | 678-568-9377
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA MARIE GRAY
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Credential | PMHNP
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Telephone | 678-568-9377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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