MEDICARE: SAVANNAH GUIDRY BURNETT 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	PA.200498	LA

General Provider Information

NPI Number	:	1588947956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH GUIDRY BURNETT PA-C

Provider Business Mailing Address
First Line	:	3635 NELSON RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-1213
Country	:	US
Telephone Number	:	337-477-0011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3635 NELSON RD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-1213
Country	:	US
Telephone Number	:	337-477-0011
Fax Number	:

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	10/25/2019

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