Healthcare Provider Details

I. General information

NPI: 1336066927
Provider Name (Legal Business Name): EGB LEGACY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 WINTERS CHAPEL RD
DORAVILLE GA
30360-1334
US

IV. Provider business mailing address

6625 WINTERS CHAPEL RD
DORAVILLE GA
30360-1334
US

V. Phone/Fax

Practice location:
  • Phone: 404-654-0682
  • Fax:
Mailing address:
  • Phone: 404-654-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH G BURNETT
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD, CEDS
Phone: 404-654-0682