Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-18-33636 | GA |
NPI | 1003477282 |
---|---|
Provider Name | Anna Leigh Burgdorf |
First Address | Athens, GA 30606-7500 |
Second Address | Athens, GA 30606-7500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |