MEDICARE: DEBRA K BURKE RD, LD, CHC

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	133VN1006X	Metabolic Nutrition Registered Dietitian		GA

General Provider Information

NPI Number	:	1427547959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA K BURKE RD, LD, CHC

Provider Business Mailing Address
First Line	:	1201 W PEACHTREE ST
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3449
Country	:	US
Telephone Number	:	770-325-8858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 W PEACHTREE ST
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3449
Country	:	US
Telephone Number	:	770-325-8858
Fax Number	:

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

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	05/10/2018

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