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2900 Chamblee Tucker Rd Bldg 16 - Atlanta GA 30341 Phone 770-939-1288 Fax 770-538-1992 UBHS Patient Referral Fax Cover Please fax this page and required referral documents to fax number 770-538-1992 Facility Name Contact Name Contact Number Date Sent Total patients referred Services Requesting Psychological/Behavioral Diagnostic Evaluation and Treatment Telehealth Psychiatric and Psychopharmacological Medication Evaluation and Management Required Referral Documentation Medicare Medicaid/Level...
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