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NPI Code Detail

MEDICARE: MISS JAMIE THOMAS BURKE PA-C

MEDICARE: MISS JAMIE THOMAS BURKE 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
1363A00000XPhysician Assistant6721GA

General Provider Information

NPI Number : 1417294216
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JAMIE THOMAS BURKE PA-C
Provider Business Mailing Address
First Line : 6175 NEWTON DR NE
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2690
Country : US
Telephone Number : 770-787-6900
Fax Number : 770-787-6962
Provider Business Practice Location Address
First Line : 6175 NEWTON DR NE
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2690
Country : US
Telephone Number : 770-787-6900
Fax Number : 770-787-6962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2013
Last Update Date : 01/22/2015

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Directions to “ MISS JAMIE THOMAS BURKE PA-C” Practice Location

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