Provider Demographics
NPI:1578364436
Name:ETRIS, HANNAH ABIGAIL
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ABIGAIL
Last Name:ETRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 REGAN MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30530-5671
Mailing Address - Country:US
Mailing Address - Phone:706-612-6693
Mailing Address - Fax:
Practice Address - Street 1:3993 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2897
Practice Address - Country:US
Practice Address - Phone:404-407-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25-419428106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician