Provider Demographics
NPI:1700352242
Name:UGA APPLIED BEHAVIOR ANALYSIS CLINIC
Entity type:Organization
Organization Name:UGA APPLIED BEHAVIOR ANALYSIS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST II
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:770-827-2410
Mailing Address - Street 1:546 ADERHOLD HALL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-0001
Mailing Address - Country:US
Mailing Address - Phone:706-369-4012
Mailing Address - Fax:
Practice Address - Street 1:546 ADERHOLD HALL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-0001
Practice Address - Country:US
Practice Address - Phone:706-369-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty