MEDICARE: ELIZABETH MAE BURKETT PA-C

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	363A00000X	Physician Assistant	11968	GA
2	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11968	OTHER	GA	STATE-LICENSE

General Provider Information

NPI Number	:	1225780885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MAE BURKETT PA-C

Provider Business Mailing Address
First Line	:	1017 COUNTY ROAD 299
Second Line	:
City	:	LANETT
State	:	AL
Zip	:	36863-5733
Country	:	US
Telephone Number	:	706-604-4604
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 20TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8920
Country	:	US
Telephone Number	:	706-660-5080
Fax Number	:

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

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	03/03/2026

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