Healthcare Provider Details

I. General information

NPI: 1184978041
Provider Name (Legal Business Name): MONICA E BURRELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA E BUFF

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 OLD MILTON PKWY
ALPHARETTA GA
30005-4626
US

IV. Provider business mailing address

2510 ROXBURGH DR
ROSWELL GA
30076-2455
US

V. Phone/Fax

Practice location:
  • Phone: 770-645-9181
  • Fax: 770-645-8455
Mailing address:
  • Phone: 770-891-5282
  • Fax: 770-645-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN205079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: