Basic Information
| Provider Information | |||||||||
| NPI: | 1558822239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTZER | ||||||||
| FirstName: | MADELINE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.S., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 JOHNSON FERRY RD NE APT S | ||||||||
| Address2: | |||||||||
| City: | BROOKHAVEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303192061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783144920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1215 HIGHTOWER TRL | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303506244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667505554 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2019 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 11934426 | GA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.