Healthcare Provider Details

I. General information

NPI: 1356314793
Provider Name (Legal Business Name): JIMENA C BURNETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HAWTHORNE RD
BLUFFTON SC
29910-4952
US

IV. Provider business mailing address

40 OKATIE CENTER BLVD S STE 100
BLUFFTON SC
29909-7519
US

V. Phone/Fax

Practice location:
  • Phone: 843-705-8888
  • Fax: 843-705-7024
Mailing address:
  • Phone: 843-705-8888
  • Fax: 843-705-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25688
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: