MEDICARE: MS. KAMEKO EDGECOMBE BURDINE CAA

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	367H00000X	Anesthesiologist Assistant	10800	GA
2	207L00000X	Anesthesiology Physician	530	FL
3	367H00000X	Anesthesiologist Assistant	530	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790336006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAMEKO EDGECOMBE BURDINE CAA

Provider Business Mailing Address
First Line	:	PO BOX 945375
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30394-5375
Country	:	US
Telephone Number	:	516-945-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 POWERS FERRY RD STE 600-236
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2919
Country	:	US
Telephone Number	:	305-810-9880
Fax Number	:

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

Provider Enumeration Date	:	09/27/2019
Last Update Date	:	11/04/2025

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Directions to “ MS. KAMEKO EDGECOMBE BURDINE CAA” Practice Location

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