Provider Demographics
NPI:1083665491
Name:BURNEY, NITASHA LARISMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NITASHA
Middle Name:LARISMA
Last Name:BURNEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3885 PRINCETON LAKES WAY SW
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5589
Mailing Address - Country:US
Mailing Address - Phone:404-629-9495
Mailing Address - Fax:404-629-9498
Practice Address - Street 1:3890 REDWINE RD SW
Practice Address - Street 2:SUITE 104
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5509
Practice Address - Country:US
Practice Address - Phone:404-629-9495
Practice Address - Fax:404-629-9498
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-08-28
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Provider Licenses
StateLicense IDTaxonomies
GA055931207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services