Provider Demographics
NPI:1548469695
Name:BURNETT, ELIZABETH GENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GENE
Last Name:BURNETT
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 1:3305 BRECKINRIDGE BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4932
Mailing Address - Country:US
Mailing Address - Phone:770-495-9775
Mailing Address - Fax:
Practice Address - Street 1:3305 BRECKINRIDGE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4932
Practice Address - Country:US
Practice Address - Phone:770-495-9775
Practice Address - Fax:770-495-9745
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002443103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000881372HMedicaid
GA1316007180OtherGROUP NPI