Healthcare Provider Details

I. General information

NPI: 1366632275
Provider Name (Legal Business Name): SHARON DENISE BURNETTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST MSC 10
MACON GA
31201-2102
US

IV. Provider business mailing address

2490 RIVERSIDE DR STE B
MACON GA
31204-1787
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-1000
  • Fax:
Mailing address:
  • Phone: 478-633-6633
  • Fax: 478-633-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN124312
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: