Provider Demographics
NPI:1548777279
Name:BUCKNER, HANNAH (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 CHEROKEE TRL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1531
Mailing Address - Country:US
Mailing Address - Phone:678-986-1913
Mailing Address - Fax:
Practice Address - Street 1:5041 DALLAS HWY BLDG 1-D
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-6459
Practice Address - Country:US
Practice Address - Phone:678-567-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-19-36008103K00000X
RBT-17-44661106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician