MEDICARE: CLARISSA DIANN BURNS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN207030	GA
2	207Q00000X	Family Medicine Physician	RN207030	GA
3	363L00000X	Nurse Practitioner	5024431	NC

General Provider Information

NPI Number	:	1568092518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA DIANN BURNS NP

Provider Business Mailing Address
First Line	:	245 JULIET DR
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-4834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 HOWELL MILL RD NW FL 8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-5557
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	05/11/2026

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