Provider Demographics
NPI:1093991796
Name:BURRELL, JENNIFER SHANNON (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHANNON
Last Name:BURRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 TREE LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:770-972-0812
Mailing Address - Fax:770-972-0850
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE 110
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-972-0812
Practice Address - Fax:770-972-0850
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics