Healthcare Provider Details

I. General information

NPI: 1427547959
Provider Name (Legal Business Name): DEBRA K BURKE RD, LD, CHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W PEACHTREE ST
ATLANTA GA
30309-3449
US

IV. Provider business mailing address

1201 W PEACHTREE ST
ATLANTA GA
30309-3449
US

V. Phone/Fax

Practice location:
  • Phone: 770-325-8858
  • Fax:
Mailing address:
  • Phone: 770-325-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: