MEDICARE: HANNAH BUCKNER MS, BCBA

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
1	103K00000X	Behavior Analyst	1-19-36008	GA
2	106S00000X	Behavior Technician	RBT-17-44661

General Provider Information

NPI Number	:	1548777279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH BUCKNER MS, BCBA

Provider Business Mailing Address
First Line	:	941 CHEROKEE TRL SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-1531
Country	:	US
Telephone Number	:	678-986-1913
Fax Number	:

Provider Business Practice Location Address
First Line	:	5041 DALLAS HWY BLDG 1-D
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-6459
Country	:	US
Telephone Number	:	678-567-7813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	06/18/2019

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