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NPI Code Detail

MEDICARE: DR. ELIZABETH GENE BURNETT PSYD

MEDICARE: DR. ELIZABETH GENE BURNETT PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY002443GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21316007180OTHERGAGROUP NPI

General Provider Information

NPI Number : 1548469695
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH GENE BURNETT PSYD
Provider Business Mailing Address
First Line : 3305 BRECKINRIDGE BLVD STE 116
Second Line :
City : DULUTH
State : GA
Zip : 30096-4932
Country : US
Telephone Number : 770-495-9775
Fax Number :
Provider Business Practice Location Address
First Line : 3305 BRECKINRIDGE BLVD STE 116
Second Line :
City : DULUTH
State : GA
Zip : 30096-4932
Country : US
Telephone Number : 770-495-9775
Fax Number : 770-495-9745
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2007
Last Update Date : 02/12/2020

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