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NPI Code Detail

MEDICARE: MRS. GINA MARIE BURBANK FNP-C

MEDICARE: MRS. GINA MARIE BURBANK FNP-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
1163W00000XRegistered NurseRN217757GA
2363LF0000XFamily Nurse PractitionerAPRN-RN217757GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11255808754OTHERGANPI NUMBER

General Provider Information

NPI Number : 1255808754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GINA MARIE BURBANK FNP-C
Provider Business Mailing Address
First Line : 531 ROSELANE ST NW STE 710
Second Line :
City : MARIETTA
State : GA
Zip : 30060-6975
Country : US
Telephone Number : 678-331-3297
Fax Number : 678-581-7187
Provider Business Practice Location Address
First Line : 6002 PROFESSIONAL PKWY STE 140
Second Line :
City : DOUGLASVILLE
State : GA
Zip : 30134-5603
Country : US
Telephone Number : 678-715-9690
Fax Number : 678-581-7140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2018
Last Update Date : 11/20/2025

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