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General NPI Number Information
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NPI Number | 1982769006
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Entity Type | Individual
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Provider Name | LE'ROY E REESE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 103 N MCDONOUGH ST REAR UNIT
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City | DECATUR
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State | GA
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Zip | 30030-3317
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Country | US
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Telephone | 404-378-7309
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Fax | 404-378-7310
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Provider Business Mailing Address
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Address Line | PO BOX 832152
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-0036
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Country | US
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Telephone | 404-378-7309
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Fax | 404-378-7310
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002464
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License Number State | GA
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