Provider Demographics
NPI:1649442260
Name:AFTON M. BURT, PH.D., P.C.
Entity type:Organization
Organization Name:AFTON M. BURT, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AFTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-534-9100
Mailing Address - Street 1:8615 ANCHOR ON LANIER CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-6785
Mailing Address - Country:US
Mailing Address - Phone:770-534-9100
Mailing Address - Fax:770-534-9104
Practice Address - Street 1:8615 ANCHOR ON LANIER CT
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-6785
Practice Address - Country:US
Practice Address - Phone:770-534-9100
Practice Address - Fax:770-534-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001728103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA332060OtherPHCS IND. PROVIDER NUMBER
GAPV138448OtherAPS HC IND. PROVIDER NUMB
GAS62970OtherUPIN
GAIP118074OtherMAGELLAN IND. NUMBER
GA68BBFJZMedicare UPIN