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General NPI Number Information
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NPI Number | 1629411590
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Entity Type | Individual
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Provider Name | BERYLE BURNETT
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Gender | Female
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 1225 CAPITOL AVE SW
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City | ATLANTA
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State | GA
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Zip | 30315-2707
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Country | US
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Telephone | 404-612-1408
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Fax | 404-893-6445
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Provider Business Mailing Address
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Address Line | 4350 WESLEY DR
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City | AUSTELL
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State | GA
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Zip | 30106-1677
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Country | US
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Telephone | 704-222-9883
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Fax | 404-893-6445
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0046
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License Number State | GA
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