Healthcare Provider Details

I. General information

NPI: 1750864211
Provider Name (Legal Business Name): HANNAH THIGPEN NORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4143 COLUMBIA RD STE B
MARTINEZ GA
30907-5405
US

IV. Provider business mailing address

4143 COLUMBIA RD SUITE B
MARTINEZ GA
30907
US

V. Phone/Fax

Practice location:
  • Phone: 706-755-2785
  • Fax: 706-755-2783
Mailing address:
  • Phone: 706-755-2785
  • Fax: 706-755-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-64642
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number10933
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-64874
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: