Provider Demographics
NPI:1952568396
Name:BURNS, MEREDITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1184753840OtherNPI (GROUP)
GA461532546EMedicaid
GA1184753840OtherNPI (GROUP)