Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 055931 | GA |
Y | 207Q00000X | Family Doctor | 055931 | GA |
NPI | 1083665491 |
---|---|
Provider Name | Dr. Nitasha Larisma Burney |
First Address | Atlanta, GA 30331-5589 |
Second Address | Atlanta, GA 30331-5509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 28/08/2012 |