Provider Demographics
NPI:1265657845
Name:EDWARDS-GAURA, ANNA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:M
Last Name:EDWARDS-GAURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:182 BEN BURTON CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-6847
Mailing Address - Country:US
Mailing Address - Phone:706-995-3160
Mailing Address - Fax:706-243-4611
Practice Address - Street 1:182 BEN BURTON CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-6847
Practice Address - Country:US
Practice Address - Phone:706-995-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002990103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily