MEDICARE: JESSICA LASHAY MCBURNETT

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548626245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LASHAY MCBURNETT

Provider Business Mailing Address
First Line	:	PO BOX 118
Second Line	:
City	:	SHANNON
State	:	GA
Zip	:	30172-0118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 PEACHTREE ST NE STE 100&200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2177
Country	:	US
Telephone Number	:	706-728-6875
Fax Number	:

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

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	07/13/2025

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