MEDICARE: AUDRA GARDENHI

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1720911423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDRA GARDENHI

Provider Business Mailing Address
First Line	:	3683 WHITE PINE RD
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30039-5139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	629 AIRPORT RD # P
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4474
Country	:	US
Telephone Number	:	167-825-5059
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ AUDRA GARDENHI ” Practice Location

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