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General NPI Number Information
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NPI Number | 1649442260
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Entity Type | Organization
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Legal Business Name | AFTON M. BURT, PH.D., P.C.
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 8615 ANCHOR ON LANIER CT
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City | GAINESVILLE
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State | GA
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Zip | 30506-6785
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Country | US
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Telephone | 770-534-9100
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Fax | 770-534-9104
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Provider Business Mailing Address
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Address Line | 8615 ANCHOR ON LANIER CT
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City | GAINESVILLE
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State | GA
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Zip | 30506-6785
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Country | US
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Telephone | 770-534-9100
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Fax | 770-534-9104
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Authorized Official
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Title or Position | PROVIDER
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Name | AFTON M BURT
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Credential | PH.D.
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Telephone | 770-534-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY001728
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License Number State | GA
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