Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CHIR010646 | GA |
NPI | 1043978497 |
---|---|
Provider Name | Dr. Amanda Marie Burns |
First Address | Woodstock, GA 30188-5047 |
Second Address | Woodstock, GA 30188-5047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CHIR010646 | (05) | GA |