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NPI Code Detail

MEDICARE: DR. ALISA JOYCE BURNETT O.D.

MEDICARE: DR. ALISA JOYCE BURNETT O.D.
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
1152W00000XOptometrist1673GA

General Provider Information

NPI Number : 1831136928
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALISA JOYCE BURNETT O.D.
Provider Business Mailing Address
First Line : 6945 DEER CREEK TRCE
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30087-5477
Country : US
Telephone Number : 404-918-1915
Fax Number : 678-267-2865
Provider Business Practice Location Address
First Line : 4221 ATLANTA HWY
Second Line :
City : LOGANVILLE
State : GA
Zip : 30052-7316
Country : US
Telephone Number : 478-368-5385
Fax Number : 478-910-1030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 05/24/2023

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