MEDICARE: DR. JANELLA LYNNE THOMAS-BURSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	043493	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164469193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANELLA LYNNE THOMAS-BURSE M.D.

Provider Business Mailing Address
First Line	:	105 CLEARBROOK PL SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8066
Country	:	US
Telephone Number	:	404-349-8024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 PHOENIX BLVD
Second Line	:	SUITE 700
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5594
Country	:	US
Telephone Number	:	404-446-4792
Fax Number	:	404-446-4793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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