Provider Demographics
NPI:1184753840
Name:MEREDITH BURNS, PSY.D., P.C.
Entity type:Organization
Organization Name:MEREDITH BURNS, PSY.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-765-2990
Mailing Address - Street 1:225 CREEKSTONE RDG STE 22
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3744
Mailing Address - Country:US
Mailing Address - Phone:770-765-2990
Mailing Address - Fax:770-234-6853
Practice Address - Street 1:225 CREEKSTONE RDG STE 22
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3744
Practice Address - Country:US
Practice Address - Phone:770-765-2990
Practice Address - Fax:770-234-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1184753840OtherNPI (GROUP)
GA1952568396OtherNPI (INDIVIDUAL)
GA461532546DMedicaid
GA1952568396OtherNPI (INDIVIDUAL)