Provider Demographics
NPI:1073254090
Name:BURKE, COURTNEY (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 JOHNSON FY RD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1607
Mailing Address - Country:US
Mailing Address - Phone:404-303-7004
Mailing Address - Fax:404-303-7020
Practice Address - Street 1:980 JOHNSON FY RD NE STE 110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1607
Practice Address - Country:US
Practice Address - Phone:404-303-7004
Practice Address - Fax:404-303-7020
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN279479163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery