Healthcare Provider Details

I. General information

NPI: 1457073843
Provider Name (Legal Business Name): MELANIE ELIZABETH BURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 GREEN ST NW STE 405
GAINESVILLE GA
30501-3366
US

IV. Provider business mailing address

146 SHORELINE CT
JEFFERSON GA
30549-2119
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-9100
  • Fax: 770-534-9104
Mailing address:
  • Phone: 770-534-9100
  • Fax: 770-534-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: