Healthcare Provider Details

I. General information

NPI: 1174353544
Provider Name (Legal Business Name): CHARIS BURHENN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COWLES CLINIC WAY - CYPRESS BLDG CY-100
GREENSBORO GA
30642-2962
US

IV. Provider business mailing address

1871 BOWDEN POND RD
GREENSBORO GA
30642-2962
US

V. Phone/Fax

Practice location:
  • Phone: 706-341-4886
  • Fax: 706-932-8222
Mailing address:
  • Phone: 770-656-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN155512
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: