Healthcare Provider Details

I. General information

NPI: 1508406737
Provider Name (Legal Business Name): JESSICA BURRIS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE STREET NE EMORY MIDTOWN - DAVIS FISCHER BLDG, 3RD FLOOR, RM 3245A
ATLANTA GA
30308
US

IV. Provider business mailing address

4831 ELM LEAF DR SW
ATLANTA GA
30331-7502
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-7858
  • Fax: 404-686-7841
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN264562
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN264562
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN264562
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: