Provider Demographics
NPI:1184230781
Name:BANGURA, ANNITA BINTA
Entity Type:Individual
Prefix:
First Name:ANNITA
Middle Name:BINTA
Last Name:BANGURA
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 1:4486 PARMALEE PATH
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-1630
Mailing Address - Country:US
Mailing Address - Phone:678-508-9176
Mailing Address - Fax:
Practice Address - Street 1:4486 PARMALEE PATH
Practice Address - Street 2:
Practice Address - City:CONLEY
Practice Address - State:GA
Practice Address - Zip Code:30288-1630
Practice Address - Country:US
Practice Address - Phone:678-508-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty