Provider Demographics
NPI:1003477282
Name:BURGDORF, ANNA LEIGH
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEIGH
Last Name:BURGDORF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WESTPARK DR APT 904
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7500
Mailing Address - Country:US
Mailing Address - Phone:706-207-8140
Mailing Address - Fax:
Practice Address - Street 1:150 WESTPARK DR APT 904
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7500
Practice Address - Country:US
Practice Address - Phone:706-207-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-18-33636103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst