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Individual

KYLE THOMAS CHURCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
95 COLLIER RD NW STE 2055, ATLANTA, GA 30309-1721
(404) 605-5699
Mailing address
264 LAKE CONNIE RD, CARROLLTON, GA 30116-5245
(404) 596-1641

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
9363
GA
363A00000X
Physician Assistant
Primary
9363
GA

Other

Enumeration date
09/14/2019
Last updated
01/21/2025
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