Provider Demographics
NPI:1861905770
Name:BORDERS, GAETANE FERDINAND (EDS)
Entity type:Individual
Prefix:MS
First Name:GAETANE
Middle Name:FERDINAND
Last Name:BORDERS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 KITTERY PT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-3119
Mailing Address - Country:US
Mailing Address - Phone:404-202-3040
Mailing Address - Fax:
Practice Address - Street 1:4060 KITTERY PT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-3119
Practice Address - Country:US
Practice Address - Phone:404-202-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA700653103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty