Shannon Leigh Wynne, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-18-30139 Issued in GA

Practice address

110 Carlton St
Athens, GA 30602-5004

Phone

(770) 827-2410

NPI assigned

Jun 20, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Uga Applied Behavior Analysis Clinic

  • Behavior Analyst
  • Athens, GA
  • NPI 1700352242
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529452800000",
    "number": "1417441627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PINYON PINE CIR APT 1101",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306065690",
            "telephone_number": "770-827-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 CARLTON ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306025004",
            "telephone_number": "770-827-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "SHANNON",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-18-30139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Godowns Wurst
• Brantley Aaron Wyatt, CAA
• James Wyatt II, CRNA
• Jennifer Laura Wyatt, NP
• Tracey Wyatt, LPC
• Wendy Wynne, LPN
• Ellen Wyzykowski
• Jack Fisher Yancey, MD
• Katherine H Yancey, MD
• Margaret Hannah Yankovich, MMSC, CAA

• Behavior Analyst in Athens, GA
• Providers in Athens, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.